MEDICARE: WITH GRACE, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1326671827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITH GRACE, LLC

Provider Business Mailing Address
First Line	:	20129 SCOTTSDALE BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-6460
Country	:	US
Telephone Number	:	216-482-1466
Fax Number	:

Provider Business Practice Location Address
First Line	:	20129 SCOTTSDALE BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-6460
Country	:	US
Telephone Number	:	216-482-1466
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANDREA NATASHA BOYD
Credential	:	MBA-CED
Telephone Number	:	216-482-1466

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	03/17/2020

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Directions to “WITH GRACE, LLC ” Practice Location

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