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General NPI Number Information
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NPI Number | 1538793435
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Entity Type | Organization
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Legal Business Name | BYGRACE HOMES, LLC
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 9940 HEATHERGATE LN
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City | MINT HILL
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State | NC
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Zip | 28227-4309
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Country | US
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Telephone | 704-904-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 9940 HEATHERGATE LN
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City | MINT HILL
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State | NC
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Zip | 28227-4309
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Country | US
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Telephone | 704-904-7532
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ OWNER
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Name | DIANA OPIYO
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Credential |
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Telephone | 704-904-7532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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