| Organization Name: | GRACE HOSPICE OF WISCONSIN, LLC |
| NPI Number: | 1336487347 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL E SMITH (CEO/AUTHORIZED OFFICIAL) |
| Mailing Address: | 2514 S. 102nd Street Ste. 276 West Allis |
| State: | WI US |
| Postal Code: | 532272147 |
| Phone Number: | 4143958650 |
| Fax Number: | 8558451846 |
| NPI Enumeration Date: | 01/25/2013 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |