MEDICARE: GRACE HAVEN

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1790631661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HAVEN

Provider Business Mailing Address
First Line	:	11185 N JENNINGS RD
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1539
Country	:	US
Telephone Number	:	810-893-8751
Fax Number	:

Provider Business Practice Location Address
First Line	:	11185 N JENNINGS RD
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1539
Country	:	US
Telephone Number	:	810-893-8751
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIANA SCOTT
Credential	:
Telephone Number	:	810-893-8751

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “GRACE HAVEN ” Practice Location

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