# GRACE SUPPORTIVE LIVING SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215395900
- **Authorized official:** MS. SAMARA L ROBERTSON LPN (OWNER/LICENSE NURSE)
- **Authorized official phone:** (770) 984-5388

## Contact information

- **Practice address:** 3350 RIVERWOOD PKWY SE, 1900, ATLANTA, GA 30339-6401
- **Practice address phone:** (770) 984-5388
- **Mailing address:** 3350 RIVERWOOD PKWY SE, 1900, ATLANTA, GA 30339-6401
- **Mailing address phone:** (770) 984-5388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | LPN0089404 | GA | — |

## Other

- **Enumeration date:** 02/09/2016
- **Last updated:** 02/18/2016