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General NPI Number Information
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NPI Number | 1053171363
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Entity Type | Organization
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Legal Business Name | GRACE AND GRATITUDE ADULT CARE LLC
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 28128 FLANDERS AVE
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City | WARREN
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State | MI
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Zip | 48088-4314
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Country | US
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Telephone | 313-926-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 28128 FLANDERS AVE
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City | WARREN
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State | MI
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Zip | 48088-4314
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Country | US
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Telephone | 313-926-7190
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | TERRY LARK
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Credential |
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Telephone | 313-926-7190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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