- Enrollment id
- O20051214000516
- Enrollment state
- NJ
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1538185830
- Multiple npi flag
- N
- Ccn
- 311563
- Associate id
- 5890716161
- Organization name
- GRACE HEALTHCARE SERVICES LLC
- Incorporation date
- 2005-09-21
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 105 FIELDCREST AVE 402
- City
- EDISON
- State
- NJ
- Zip code
- 088373628