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General NPI Number Information
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NPI Number | 1780480582
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Entity Type | Organization
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Legal Business Name | TRUE GRACE CLINIC LTD
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 01/04/2026
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Provider Practice Location Address
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Address Line | 1300 NORTHRIDGE CT NW STE 2
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City | PINE CITY
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State | MN
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Zip | 55063-5846
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Country | US
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Telephone | 320-372-2312
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Fax |
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Provider Business Mailing Address
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Address Line | 501 MAIN ST
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City | SANDSTONE
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State | MN
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Zip | 55072-4410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP COMPLIANCE
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Name | TINA KELLER
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Credential |
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Telephone | 320-372-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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