Provider Demographics
NPI:1679088819
Name:INSPIRED GRACE HEALTHCARE, INC
Entity type:Organization
Organization Name:INSPIRED GRACE HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-484-0596
Mailing Address - Street 1:1051 E MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2455
Mailing Address - Country:US
Mailing Address - Phone:224-484-0596
Mailing Address - Fax:
Practice Address - Street 1:1051 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2455
Practice Address - Country:US
Practice Address - Phone:224-484-0596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000567251J00000X
IL3001606253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care