# GRACE HOME CARE PROVIDER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE HOME CARE PROVIDER LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992560262
- **Authorized official:** GAELLE FOKOU MASSA (ADMINISTRATOR)
- **Authorized official phone:** (912) 343-6454

## Contact information

- **Practice address:** 22 TRASK CIR, HINESVILLE, GA 31313-1197
- **Practice address phone:** (912) 343-6454
- **Mailing address:** 22 TRASK CIR, HINESVILLE, GA 31313-1197
- **Mailing address phone:** (912) 343-6454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |

## Other

- **Enumeration date:** 02/15/2024
- **Last updated:** 04/09/2024