Provider Demographics
NPI:1679313225
Name:GRACE PATH LLC
Entity type:Organization
Organization Name:GRACE PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-575-4849
Mailing Address - Street 1:12195 ELK RDG
Mailing Address - Street 2:
Mailing Address - City:WESLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72773-9109
Mailing Address - Country:US
Mailing Address - Phone:479-225-3505
Mailing Address - Fax:
Practice Address - Street 1:12195 ELK RDG
Practice Address - Street 2:
Practice Address - City:WESLEY
Practice Address - State:AR
Practice Address - Zip Code:72773-9109
Practice Address - Country:US
Practice Address - Phone:479-225-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies