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General NPI Number Information
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NPI Number | 1952253163
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN HOME LLC
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 4767 HOUSTON RD APT 3113
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City | FLORENCE
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State | KY
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Zip | 41042-4815
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Country | US
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Telephone | 678-368-0359
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Fax |
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Provider Business Mailing Address
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Address Line | 4767 HOUSTON RD APT 3113
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City | FLORENCE
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State | KY
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Zip | 41042-4815
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Country | US
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Telephone | 678-368-0359
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LENA BREWER
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Credential |
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Telephone | 678-368-0359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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