Healthcare Provider Details

I. General information

NPI: 1851976039
Provider Name (Legal Business Name): GRACE ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 FLEUR DRIVE
DES MOINES IA
50321-5026
US

IV. Provider business mailing address

1441 29TH ST STE 115
WEST DES MOINES IA
50266-1309
US

V. Phone/Fax

Practice location:
  • Phone: 515-444-8642
  • Fax:
Mailing address:
  • Phone: 515-444-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAYLEY VENARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-537-1065