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General NPI Number Information
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NPI Number | 1558095240
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Entity Type | Individual
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Provider Name | JAMIE M GRACE
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 634 APPLEWOOD ST NE
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City | ROANOKE
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State | VA
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Zip | 24019-5603
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Country | US
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Telephone | 540-795-5175
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12504
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City | ROANOKE
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State | VA
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Zip | 24026-2504
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Country | US
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Telephone | 540-795-5175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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