Healthcare Provider Details

I. General information

NPI: 1154279123
Provider Name (Legal Business Name): THE GRACE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 W 10 MILE RD STE 130
SOUTHFIELD MI
48033-3182
US

IV. Provider business mailing address

23800 W 10 MILE RD STE 130
SOUTHFIELD MI
48033-3182
US

V. Phone/Fax

Practice location:
  • Phone: 248-996-9134
  • Fax:
Mailing address:
  • Phone: 248-996-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MISS TERRI GRACE COOPER
Title or Position: ADMINISTRATOR/SOCIAL WORKER
Credential: BSW
Phone: 248-996-9134