Healthcare Provider Details

I. General information

NPI: 1821699091
Provider Name (Legal Business Name): AW GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 06/21/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 ROUTE 211 E STE 8
MIDDLETOWN NY
10941-1460
US

IV. Provider business mailing address

779 ROUTE 211 E STE 8
MIDDLETOWN NY
10941-1460
US

V. Phone/Fax

Practice location:
  • Phone: 845-673-1115
  • Fax:
Mailing address:
  • Phone: 845-673-1115
  • 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: ANN MARIE DEER
Title or Position: CEO
Credential:
Phone: 845-673-1115