=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487829073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 04/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1318 RAMSEY ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-484-4055
-----------------------------------------------------
Fax | 910-486-4404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1318 RAMSEY ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-484-4055
-----------------------------------------------------
Fax | 910-486-4404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MR. ROWLAND NGOZI ACHUKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-484-4055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------