NPIMap

Organization Active NPI

Grace Reliant Health Services, LLC

  • Home Health Agency
  • Cape Girardeau, MO
National Provider Identifier
1013266436
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
861-HH Issued in MO
Legal business name
GRACE RELIANT HEALTH SERVICES, LLC
Practice address
2749 Thomas Dr
Cape Girardeau, MO 63701-2131
Phone
(573) 803-5009
Fax
(573) 803-5008
NPI assigned
Aug 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan K Stone
Title
Member Partner
Phone
(573) 803-5002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 861-HH MO Primary

Addresses

Primary practice location

2749 Thomas Dr
Cape Girardeau, MO 63701-2131

Mailing address

2749 Thomas Dr
Cape Girardeau, MO 63701-2131
Phone (573) 803-5009

Other identifiers 2

IdentifierTypeStateIssuer
861-HHMedicaidMO
1013266436MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130211000141 MO Part A Provider - Home Health Agency 9234383720 Practice locations: Cape Girardeau, MO

Home health agency certification: CCN 267646

Legal name
GRACE RELIANT HEALTH SERVICES, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 1, 2013
Last certification
Oct 1, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Aug 28, 2012 in MO
Enrollment address
2749 Thomas Dr
Cape Girardeau, MO 63701-2131

Care Compare: Home health agency

Medicare Care Compare
Listed as
Grace Reliant Health Services, LLCCCN 267646
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Nov 1, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2049327Grace Reliant Health Services2749 Thomas Dr, Cape Girardeau, MO 63701Certificate of waiverJun 12, 2028

National Provider Directory

National Provider Directory

Locations

2845 Independence St
Cape Girardeau, MO 63703
Phone (573) 803-5002

2749 Thomas Dr
Cape Girardeau, MO 63701
Phone (573) 803-5009

2370 N High St
Ste 5
Jackson, MO 63755
Phone (573) 204-7620

160 N Enterprise Ln
Jackson, MO 63755
Phone (573) 204-9200

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carolyn Fisher Individual W-2 Managing EmployeeAdministrator/Director of Nursing Nov 1, 2021 100%
Operational/Managerial ControlAdministrator/Director of Nursing Nov 1, 2021 100%
Samuel Duer Individual 5% Or Greater Direct Ownership Interest Aug 1, 2016 50%
Corporate OfficerPresident-Board of Directors Jan 10, 2013
Susan K Stone Individual 5% Or Greater Direct Ownership Interest Aug 1, 2016 50%
Corporate OfficerVice President - Board of Directors Jan 10, 2013

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 23

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1013266436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2749 THOMAS DR",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012131",
            "telephone_number": "573-803-5009",
            "fax_number": "573-803-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2749 THOMAS DR",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012131",
            "telephone_number": "573-803-5009",
            "fax_number": "573-803-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE RELIANT HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-30",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEMBER PARTNER",
        "authorized_official_telephone_number": "573-803-5002"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": "861-HH",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "861-HH",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013266436",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.