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General NPI Number Information
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NPI Number | 1891511580
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Entity Type | Organization
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Legal Business Name | THE GRACE SPACE
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1740 SUPERIOR ST
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City | LINCOLN
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State | NE
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Zip | 68521-1502
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Country | US
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Telephone | 402-356-5885
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Fax | 402-356-5884
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Provider Business Mailing Address
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Address Line | 1740 SUPERIOR ST
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City | LINCOLN
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State | NE
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Zip | 68521-1502
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Country | US
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Telephone | 402-356-5885
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Fax | 402-356-5884
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KELLY SUZANNE SPARR
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Credential | LPN
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Telephone | 402-770-9089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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