Provider Demographics
NPI:1053693739
Name:GRACE HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:GRACE HEALTH SYSTEM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARROJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-983-0666
Mailing Address - Street 1:7840 LINCOLN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3658
Mailing Address - Country:US
Mailing Address - Phone:847-983-0666
Mailing Address - Fax:847-983-4916
Practice Address - Street 1:7840 LINCOLN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3658
Practice Address - Country:US
Practice Address - Phone:847-983-0666
Practice Address - Fax:847-983-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2049431251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health