Healthcare Provider Details

I. General information

NPI: 1659275758
Provider Name (Legal Business Name): GRACE MENTAL & MEDICAL HEALTHCARE SERVICES PLCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 DUGOUT TRL
CAROL STREAM IL
60188-3327
US

IV. Provider business mailing address

862 DUGOUT TRL
CAROL STREAM IL
60188-3327
US

V. Phone/Fax

Practice location:
  • Phone: 630-946-7549
  • Fax:
Mailing address:
  • Phone: 630-946-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ABRAHAM Y. LUBA
Title or Position: NURSE PRACTITIONER
Credential: FNP/PMHNP
Phone: 630-946-7549