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
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1720810682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HEALTH, INC.

Provider Business Mailing Address
First Line	:	181 EMMETT ST W
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49037-2963
Country	:	US
Telephone Number	:	269-966-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	8175 C DR N RM 10
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-7548
Country	:	US
Telephone Number	:	269-441-3250
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	PETER S CHANG
Credential	:
Telephone Number	:	269-965-8866

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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