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General NPI Number Information
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NPI Number | 1326615600
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Entity Type | Organization
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Legal Business Name | GRACE ASSISTED LIVING FACILITY LLC
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 6746 MASSACHUSETTS DR
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City | LAKE WORTH
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State | FL
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Zip | 33462-3836
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Country | US
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Telephone | 561-966-9535
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Fax | 561-966-9535
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Provider Business Mailing Address
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Address Line | 6746 MASSACHUSETTS DR
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City | LAKE WORTH
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State | FL
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Zip | 33462-3836
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Country | US
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Telephone | 561-966-9535
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Fax | 561-966-9535
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Authorized Official
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Title or Position | OWNER
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Name | MS. KETTELIE HENRY
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Credential | MSN, APRN
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Telephone | 561-254-2352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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