Healthcare Provider Details

I. General information

NPI: 1649130444
Provider Name (Legal Business Name): GREATER GRACE GROUP HOME INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 FAIRCROFT WAY
MONROE NC
28110-8837
US

IV. Provider business mailing address

2809 FAIRCROFT WAY
MONROE NC
28110-8837
US

V. Phone/Fax

Practice location:
  • Phone: 256-348-5648
  • Fax:
Mailing address:
  • Phone: 256-348-5648
  • 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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY ABOSEDE OLABODE
Title or Position: PRESIDENT
Credential: RN, MSN
Phone: 256-348-5648