NPIMap

Organization Active NPI

Grace Supportive Living Services LLC

  • Home Health Agency
  • Atlanta, GA
National Provider Identifier
1215395900
Registry record updated Feb 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GRACE SUPPORTIVE LIVING SERVICES LLC
Practice address
3350 Riverwood Pkwy SE
1900
Atlanta, GA 30339-6401
Phone
(770) 984-5388
NPI assigned
Feb 9, 2016
Last updated
Feb 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2016

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

Authorized official

Name
Ms. Samara L Robertson, LPN
Title
Owner/License Nurse
Phone
(770) 984-5388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
In Home Supportive Care Agency 253Z00000X LPN0089404 GA

Addresses

Primary practice location

3350 Riverwood Pkwy SE
1900
Atlanta, GA 30339-6401

Mailing address

3350 Riverwood Pkwy SE
1900
Atlanta, GA 30339-6401
Phone (770) 984-5388

Other identifiers 1

IdentifierTypeStateIssuer
1154604015OtherGAMEDICARE MEDICAID

National Provider Directory

National Provider Directory
Tax ID family
Grace Supportive Living Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1215395900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 RIVERWOOD PKWY SE",
            "address_2": "1900",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303396401",
            "telephone_number": "770-984-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 RIVERWOOD PKWY SE",
            "address_2": "1900",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303396401",
            "telephone_number": "770-984-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE SUPPORTIVE LIVING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "SAMARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/LICENSE NURSE",
        "authorized_official_telephone_number": "770-984-5388",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "GA",
            "license": "LPN0089404",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MEDICAID",
            "identifier": "1154604015",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.