Healthcare Provider Details

I. General information

NPI: 1891170411
Provider Name (Legal Business Name): GRACE PLACE ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LIBERTY RD
LEXINGTON KY
40509-4319
US

IV. Provider business mailing address

2100 LIBERTY RD
LEXINGTON KY
40509-4319
US

V. Phone/Fax

Practice location:
  • Phone: 859-539-2147
  • Fax:
Mailing address:
  • Phone: 859-539-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750189
License Number StateKY

VIII. Authorized Official

Name: MS. DG GRIDLEY
Title or Position: DIRECTOR
Credential: MHA
Phone: 859-539-2147