Healthcare Provider Details

I. General information

NPI: 1073078671
Provider Name (Legal Business Name): GRACE CENTER FOR ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 NW SPRUCE AVE
CORVALLIS OR
97330-2112
US

IV. Provider business mailing address

980 NW SPRUCE AVE
CORVALLIS OR
97330-2112
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-8417
  • Fax:
Mailing address:
  • Phone: 541-754-8417
  • 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: RENE KNIGHT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 541-754-8417