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General NPI Number Information
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NPI Number | 1760868905
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Entity Type | Organization
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Legal Business Name | SHERYL H GRACE
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 180 THACKER RD
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City | RURAL HALL
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State | NC
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Zip | 27045-9629
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Country | US
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Telephone | 336-705-1763
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Fax |
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Provider Business Mailing Address
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Address Line | 180 THACKER RD
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City | RURAL HALL
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State | NC
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Zip | 27045-9629
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Country | US
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Telephone | 336-705-1763
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHERYL HUGHEY GRACE
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Credential | PHD
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Telephone | 336-705-1763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | WS-2015-01
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License Number State | NC
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