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NPI Code Detail

MEDICARE: GRACE HEALTH, INC.

MEDICARE: GRACE HEALTH, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1231836OTHERMEDICARE LOCATION NUMBER
30A36090OTHERMEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2700A360900OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1518945278
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE HEALTH, INC.
Provider Business Mailing Address
First Line : 181 W EMMETT ST
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49037-2963
Country : US
Telephone Number : 269-966-2600
Fax Number : 269-965-4773
Provider Business Practice Location Address
First Line : 181 W EMMETT ST
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49037-2963
Country : US
Telephone Number : 269-966-2600
Fax Number : 269-965-4773
Authorized Official
Title or Position : PRESIDENT / CEO
Name : PETER S CHANG
Credential : MD
Telephone Number : 269-965-8866
Provider Enumeration Date : 01/04/2006
Last Update Date : 02/16/2018

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Directions to “GRACE HEALTH, INC. ” Practice Location

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