Healthcare Provider Details

I. General information

NPI: 1295240042
Provider Name (Legal Business Name): GRACE ADULT DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 S HAVANA ST
AURORA CO
80014-1014
US

IV. Provider business mailing address

2060 S HAVANA ST
AURORA CO
80014-1014
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-0036
  • Fax:
Mailing address:
  • Phone: 303-750-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator
License NumberRN0185593
License Number StateCO

VIII. Authorized Official

Name: YEONG S RICHARDSON
Title or Position: REGISTERED NURSE/ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 720-277-5116