Organization
GRACE & FAITH CARE AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANELYS REYES (OWNER)
(863) 808-3994
Entity
Organization
Contact information
Practice address
213 KERNEYWOOD ST STE 8, LAKELAND, FL 33803-2947
(863) 608-6831
Mailing address
213 KERNEYWOOD ST STE 8, LAKELAND, FL 33803-2947
(863) 608-6831
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30212449
AHCA
FL
Enumeration date
09/13/2022
Last updated
10/27/2022
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