Healthcare Provider Details

I. General information

NPI: 1346926599
Provider Name (Legal Business Name): GRACE INTEGRATED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HIGHLAND AVE STE 325
LOMBARD IL
60148-5390
US

IV. Provider business mailing address

414 PLAZA DR STE 301
WESTMONT IL
60559-5508
US

V. Phone/Fax

Practice location:
  • Phone: 630-728-1744
  • Fax:
Mailing address:
  • Phone: 708-512-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE MARIE MCDEVITT
Title or Position: OWNER
Credential: MA
Phone: 708-512-5555