NPIMap

Organization Active NPI

Grace Home Health Care, LLC

  • Home Health Agency
  • Mesa, AZ
National Provider Identifier
1881826766
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GRACE HOME HEALTH CARE, LLC
Practice address
2220 S Country Club Dr Ste 107
Mesa, AZ 85210-6808
Phone
(480) 497-0302
Fax
(480) 497-0305
NPI assigned
Aug 11, 2009
Last updated
Jul 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Mr. Jamal G Mansur
Title
Administrator
Phone
(803) 995-8324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

2220 S Country Club Dr Ste 107
Mesa, AZ 85210-6808

Mailing address

1930 S Alma School Rd Ste B206
Mesa, AZ 85210-3041
Phone (480) 497-0302

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090909000572 AZ Part A Provider - Home Health Agency 0446305767 Practice locations: Mesa, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881826766. Details of each certification follow.

Home health agency certification: CCN 037273

Legal name
GRACE HOME HEALTH CARE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 3, 2010
Last certification
Jan 31, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
May 20, 2009 in AZ
Enrollment address
2220 S Country Club Dr
Ste 107
Mesa, AZ 85210-6808

Care Compare: Home health agency

Medicare Care Compare
Listed as
Grace Home Health CareCCN 037273 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Mar 3, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, 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
03D2039003Grace Home Health Care, LLC2220 S Country Club Dr Ste 107, Mesa, AZ 85210Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory

Locations

1450 W Guadalupe Rd
Ste 128
Gilbert, AZ 85233
Phone (248) 464-4920

1930 S Alma School Rd
Ste B201
Mesa, AZ 85210

1930 S Alma School Rd
Ste B206
Mesa, AZ 85210

1930 S Alma School Rd
Ste B219
Mesa, AZ 85210
Phone (480) 497-0302

2220 S Country Club Dr
Ste 107
Mesa, AZ 85210
Phone (480) 497-0302

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jamal G Mansur Individual 5% Or Greater Direct Ownership InterestOwner Sep 15, 2016 50%
Corporate OfficerOwner Sep 15, 2016 50%
Fleurdeliz F Magbanua Individual 5% Or Greater Direct Ownership InterestOwner Sep 15, 2016 50%
W-2 Managing EmployeeOwner Sep 15, 2016 50%

Practitioners & affiliated clinicians

Affiliated clinicians 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1881826766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 S ALMA SCHOOL RD STE B206",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103041",
            "telephone_number": "480-497-0302",
            "fax_number": "480-497-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 S COUNTRY CLUB DR STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106808",
            "telephone_number": "480-497-0302",
            "fax_number": "480-497-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HOME HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-11",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "MANSUR",
        "authorized_official_first_name": "JAMAL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-995-8324",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.