Healthcare Provider Details

I. General information

NPI: 1700018405
Provider Name (Legal Business Name): GRACE C MAE ADVOCATE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 33RD AVE SW STE J
CEDAR RAPIDS IA
52404-4646
US

IV. Provider business mailing address

260 33RD AVE SW STE J
CEDAR RAPIDS IA
52404-4646
US

V. Phone/Fax

Practice location:
  • Phone: 319-361-6529
  • Fax: 319-343-1059
Mailing address:
  • Phone: 319-361-6529
  • Fax: 319-343-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA CAROLYN GILBAUGH
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 319-361-6529