Healthcare Provider Details

I. General information

NPI: 1871342618
Provider Name (Legal Business Name): UNITY GRACE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 NORTH NASH STREET STE B
WILSON NC
27896
US

IV. Provider business mailing address

2509B NASH ST NW
WILSON NC
27896-1311
US

V. Phone/Fax

Practice location:
  • Phone: 252-205-8649
  • Fax:
Mailing address:
  • Phone: 252-777-3153
  • Fax: 252-616-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: QUANISHA MARIE KING
Title or Position: CEO/ADMINISTRATOR
Credential: RN
Phone: 252-777-3153