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36D2192734 CLIA NUMBER - HIS GRACE HOME HEALTH CARE LLC

Laboratory Demographics

CLIA Number: 36D2192734

Facility Name: HIS GRACE HOME HEALTH CARE LLC

Facility Address:
1415 EAST DUBLIN-GRANVILLE RD SUITE 204
COLUMBUS, OH
ZIP 43229
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Facility Phone Number: 614 556-1079

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1255946497

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 36D2192734
LAB Type Home Health Agency
Facility Name HIS GRACE HOME HEALTH CARE LLC
Street 1415 EAST DUBLIN-GRANVILLE RD SUITE 204
City COLUMBUS
State OH
ZIP 43229
Phone 614 556-1079
CertificateType 4
CertificateEffectiveDate 9/14/2022
CertificateExpirationDate 9/13/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024