MEDICARE: GRACE ADULT DAY CARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator	RN0185593	CO

General Provider Information

NPI Number	:	1295240042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE ADULT DAY CARE CENTER LLC

Provider Business Mailing Address
First Line	:	2060 S HAVANA ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1014
Country	:	US
Telephone Number	:	303-750-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 S HAVANA ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1014
Country	:	US
Telephone Number	:	303-750-0036
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE/ADMINISTRATOR
Name	:	YEONG S RICHARDSON
Credential	:	REGISTERED NURSE
Telephone Number	:	720-277-5116

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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