Healthcare Provider Details

I. General information

NPI: 1275211971
Provider Name (Legal Business Name): GRACE ESTATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NE VENTURE DR
WAUKEE IA
50263-9411
US

IV. Provider business mailing address

801 NE VENTURE DR
WAUKEE IA
50263-9411
US

V. Phone/Fax

Practice location:
  • Phone: 515-415-4348
  • Fax: 515-864-0223
Mailing address:
  • Phone: 515-415-4348
  • Fax: 515-864-0223

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: MR. DAVID BAKER
Title or Position: MANAGING PARTNER
Credential:
Phone: 763-898-2053