Healthcare Provider Details

I. General information

NPI: 1104623404
Provider Name (Legal Business Name): GRACE HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LINCOLN ST
LEOMINSTER MA
01453-1770
US

IV. Provider business mailing address

130 LINCOLN ST
LEOMINSTER MA
01453-1770
US

V. Phone/Fax

Practice location:
  • Phone: 508-373-6343
  • Fax:
Mailing address:
  • Phone: 508-373-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY THULARE
Title or Position: COE/DIRECTOR
Credential:
Phone: 508-373-6343