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General NPI Number Information
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NPI Number | 1336861863
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Entity Type | Organization
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Legal Business Name | GODS GRACE INC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 16431 DOBSON AVE
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2512
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Country | US
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Telephone | 872-222-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 16431 DOBSON AVE
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2512
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Country | US
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Telephone | 872-222-8450
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHATONNA MILLER
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Credential |
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Telephone | 773-678-0886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 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 #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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