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General NPI Number Information
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NPI Number | 1821699091
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Entity Type | Organization
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Legal Business Name | AW GRACE LLC
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 779 ROUTE 211 E STE 8
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City | MIDDLETOWN
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State | NY
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Zip | 10941-1460
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Country | US
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Telephone | 845-673-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 779 ROUTE 211 E STE 8
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City | MIDDLETOWN
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State | NY
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Zip | 10941-1460
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Country | US
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Telephone | 845-673-1115
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANN MARIE DEER
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Credential |
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Telephone | 845-673-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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