Provider Demographics
NPI:1093875742
Name:GRACE, CHERYL IRENE
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:IRENE
Last Name:GRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3105
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-3105
Mailing Address - Country:US
Mailing Address - Phone:530-872-9140
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-891-2784
Practice Address - Fax:530-891-2809
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator