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General NPI Number Information
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NPI Number | 1891170411
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Entity Type | Organization
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Legal Business Name | GRACE PLACE ADULT DAY CENTER LLC
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 2100 LIBERTY RD
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City | LEXINGTON
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State | KY
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Zip | 40509-4319
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Country | US
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Telephone | 859-539-2147
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 LIBERTY RD
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City | LEXINGTON
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State | KY
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Zip | 40509-4319
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Country | US
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Telephone | 859-539-2147
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DG GRIDLEY
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Credential | MHA
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Telephone | 859-539-2147
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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 | 750189
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License Number State | KY
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