Grace Home Care Provider LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

GRACE HOME CARE PROVIDER LLC

Practice address

22 Trask Cir
Hinesville, GA 31313-1197

Phone

(912) 343-6454

NPI assigned

Feb 15, 2024

Organization subpart

No

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

Authorized official

Name

Gaelle Fokou Massa

Title

Administrator

Phone

(912) 343-6454

Specialties & licenses 1

Addresses

Other names 1

• GRACE HOME CARE PROVIDER LLC Former legal business name

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1992560262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 TRASK CIR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313131197",
            "telephone_number": "912-343-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 TRASK CIR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313131197",
            "telephone_number": "912-343-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HOME CARE PROVIDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "MASSA",
        "authorized_official_first_name": "GAELLE",
        "authorized_official_middle_name": "FOKOU",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-343-6454"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRACE HOME CARE PROVIDER LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "GRACE HOME CARE PROVIDER LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Katelyn Elizabeth Gober
• Jacqueline Goble
• Ines Gonzalez-Torres, MD
• Nechelle Gordon
• Kari Govignon
• Jacqueline Jarvis Graham
• Sarah Paige Graham
• Kiyana Granados
• Debbie S Granger, RN, BSN
• Lauren Brooke Grant, NP

• In Home Supportive Care Agency in Hinesville, GA
• Providers in Hinesville, GA by specialty
• In Home Supportive Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.