1134160534 NPI number — GRACE HEALTH, INC.

Table of content: (NPI 1134160534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134160534 NPI number — GRACE HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE HEALTH, 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:
1134160534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 W EMMETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49037-2963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-965-8866
Provider Business Mailing Address Fax Number:
269-965-4773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MARKET PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49224-1767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-629-6540
Provider Business Practice Location Address Fax Number:
517-629-6589
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0A36090 . This is a "MEDICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 231885 . This is a "MEDICARE LOCATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700A311700 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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