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General NPI Number Information
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NPI Number | 1114197969
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Entity Type | Organization
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Legal Business Name | GRACE OF SERENITY LIVING, INC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 8340 N 86TH LN
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City | PEORIA
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State | AZ
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Zip | 85345-2553
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Country | US
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Telephone | 602-441-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 E THOMAS RD B-200
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City | PHOENIX
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State | AZ
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Zip | 85016-8299
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Country | US
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Telephone | 602-441-4690
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. TAMMY R MEADE
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Credential |
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Telephone | 602-441-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | BH2333
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License Number State | AZ
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