1609021229 NPI number — GRACE THERAPY, INC

Table of content: (NPI 1609021229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609021229 NPI number — GRACE THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609021229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6625 HIGHWAY 53 EAST
Provider Second Line Business Mailing Address:
SUITE 410-223
Provider Business Mailing Address City Name:
DAWSONVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-444-5166
Provider Business Mailing Address Fax Number:
706-216-3741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6625 HIGHWAY 53 EAST
Provider Second Line Business Practice Location Address:
SUITE 410-223
Provider Business Practice Location Address City Name:
DAWSONVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-444-5166
Provider Business Practice Location Address Fax Number:
706-216-3741
Provider Enumeration Date:
11/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VOLK
Authorized Official First Name:
CARL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-444-5166

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 326130341A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".