Healthcare Provider Details

I. General information

NPI: 1326896127
Provider Name (Legal Business Name): GRACE FOR H.O.P.E.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8153 CANTERBURY LAKE BLVD
TAMPA FL
33619-6681
US

IV. Provider business mailing address

20307 ASH GROVE LN
TAMPA FL
33647-3469
US

V. Phone/Fax

Practice location:
  • Phone: 813-569-8699
  • Fax:
Mailing address:
  • Phone: 813-569-8699
  • Fax: 813-315-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE T BEE
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 813-569-8699