Healthcare Provider Details

I. General information

NPI: 1205672417
Provider Name (Legal Business Name): FAITH&GRACE ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 RICHARDS AVE NW
GRAND RAPIDS MI
49504-5453
US

IV. Provider business mailing address

15422 ARROWHEAD RIDGE DR
HUMBLE TX
77396-4873
US

V. Phone/Fax

Practice location:
  • Phone: 313-310-2632
  • Fax:
Mailing address:
  • Phone: 313-310-2632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KARIN M NALUNKUUMA
Title or Position: OWNER
Credential:
Phone: 313-310-2632