Provider Demographics
NPI:1134667884
Name:GRACIES PLACE INC.
Entity Type:Organization
Organization Name:GRACIES PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-966-6474
Mailing Address - Street 1:4404 RIB MOUNTAIN DR # 143
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-6606
Mailing Address - Country:US
Mailing Address - Phone:715-966-6474
Mailing Address - Fax:
Practice Address - Street 1:1441 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2887
Practice Address - Country:US
Practice Address - Phone:715-966-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health