MEDICARE: GRACEPOINT SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457289530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEPOINT SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	6715 TRINITY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1309
Country	:	US
Telephone Number	:	267-690-2458
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 TRINITY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1309
Country	:	US
Telephone Number	:	267-690-2458
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAUHEDAH D CRYOR
Credential	:
Telephone Number	:	267-690-2458

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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