MEDICARE: GREATER GRACE GROUP HOME INCORPORATED

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770443590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER GRACE GROUP HOME INCORPORATED

Provider Business Mailing Address
First Line	:	2809 FAIRCROFT WAY
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-8837
Country	:	US
Telephone Number	:	704-441-8363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2809 FAIRCROFT WAY
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-8837
Country	:	US
Telephone Number	:	704-441-8363
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARY ABOSEDE OLABODE
Credential	:	RN, MSN
Telephone Number	:	256-348-5648

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	12/02/2025

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