Healthcare Provider Details

I. General information

NPI: 1467267310
Provider Name (Legal Business Name): GRACE AND RUTH'S HOUSE OF WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BROOKSTONE CIR
CANTON MI
48188-7957
US

IV. Provider business mailing address

4389 BROOKSTONE CIR
CANTON MI
48188-7957
US

V. Phone/Fax

Practice location:
  • Phone: 313-805-2060
  • Fax:
Mailing address:
  • Phone: 313-805-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXIS TREADAWAY
Title or Position: LICENSE PRACTICAL NURSE
Credential: LPN
Phone: 313-805-2060