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General NPI Number Information
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NPI Number | 1780441386
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Entity Type | Organization
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Legal Business Name | GRACE GROUP HOMES, LLC
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 633 GRACE ST
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City | GASTONIA
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State | NC
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Zip | 28052-2380
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Country | US
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Telephone | 518-469-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 633 GRACE ST
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City | GASTONIA
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State | NC
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Zip | 28052-2380
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Country | US
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Telephone | 518-469-2129
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. IRMA ROBIN DUGUE
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Credential | LPN
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Telephone | 518-469-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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