Provider Demographics
NPI:1053883488
Name:IMMANUELS GRACE HOMECARE INC
Entity type:Organization
Organization Name:IMMANUELS GRACE HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:GURUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-808-2714
Mailing Address - Street 1:321 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1607
Mailing Address - Country:US
Mailing Address - Phone:315-883-0499
Mailing Address - Fax:315-883-0594
Practice Address - Street 1:321 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1607
Practice Address - Country:US
Practice Address - Phone:315-883-0499
Practice Address - Fax:315-883-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty