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General NPI Number Information
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NPI Number | 1366761124
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Entity Type | Organization
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Legal Business Name | GRACE
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 8590 CRANBERRY LN
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City | PICKERINGTON
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State | OH
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Zip | 43147-9441
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Country | US
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Telephone | 614-554-6671
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Fax |
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Provider Business Mailing Address
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Address Line | 8590 CRANBERRY LN
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City | PICKERINGTON
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State | OH
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Zip | 43147-9441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | MS. GRACE TITILOLA LADIPO
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Credential |
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Telephone | 614-554-6671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 137701
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 137701
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License Number State | OH
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