Healthcare Provider Details

I. General information

NPI: 1699618785
Provider Name (Legal Business Name): ENORMOUS GRACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 GAMMON LN
FOUNTAIN INN SC
29644-6262
US

IV. Provider business mailing address

407 GAMMON LN
FOUNTAIN INN SC
29644-6262
US

V. Phone/Fax

Practice location:
  • Phone: 864-334-8444
  • Fax:
Mailing address:
  • Phone: 864-334-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY STOKER
Title or Position: OWNER
Credential:
Phone: 864-334-8444