Organization Name: | GRACE SUPPORTIVE LIVING SERVICES LLC |
NPI Number: | 1215395900 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SAMARA L ROBERTSON (OWNER/LICENSE NURSE) |
Mailing Address: | 3350 Riverwood Pkwy Se 1900 Atlanta |
State: | GA US |
Postal Code: | 303396401 |
Phone Number: | 7709845388 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2016 |
NPI Last Update Date: | 02/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | LPN0089404 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |