Healthcare Provider Details

I. General information

NPI: 1417719113
Provider Name (Legal Business Name): THE GRACE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
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: 410-929-3691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DORINDA G COLE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 313-999-0474