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General NPI Number Information
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NPI Number | 1417719113
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Entity Type | Organization
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Legal Business Name | THE GRACE HOUSE
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 23800 W 10 MILE RD STE 130
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3182
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Country | US
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Telephone | 410-929-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 23800 W 10 MILE RD STE 130
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3182
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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 | PRESIDENT/OWNER
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Name | MRS. DORINDA G COLE
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Credential |
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Telephone | 313-999-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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