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General NPI Number Information
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NPI Number | 1124879572
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Entity Type | Organization
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Legal Business Name | SOUL GRACE COACHING CO,
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 4000 TOWN CTR STE 1350
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1427
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Country | US
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Telephone | 586-339-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 27378 PARKVIEW BLVD APT 4314
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City | WARREN
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State | MI
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Zip | 48092-3501
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Country | US
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Telephone | 586-339-2178
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CLAUDE GRACY JR.
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Credential |
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Telephone | 586-339-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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