Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
261QP2300X | |||
Clinic/Center |
261Q00000X | |||
Rural Health |
261QR1300X | B4[14] | Rural Health Clinic |
| NPI Number | 1336919091 |
| LBN Legal business name | AGING GRACE HOUSE CALLS, PROFESSIONAL CORPORATION |
| Authorized official | KATHRYN MORDINO - (CEO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 01/04/2024 |
| Last updated | 02/26/2024 - About 2 years ago |
| Identifiers | n/a |
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