1043524127 NPI number — GRACE HEALTHCARE SOLUTIONS, INC.

Table of content: (NPI 1043524127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043524127 NPI number — GRACE HEALTHCARE SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE HEALTHCARE SOLUTIONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043524127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 W AVENUE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLE GLADE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33430-3019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-993-6004
Provider Business Mailing Address Fax Number:
561-993-1111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7368 STATE ROAD 15, US 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHOKEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-993-6004
Provider Business Practice Location Address Fax Number:
561-993-1111
Provider Enumeration Date:
08/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HURBS
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
561-993-6004

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003557700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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