Provider Demographics
NPI:1235909193
Name:GREATER GRACE HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:GREATER GRACE HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWASEUN
Authorized Official - Middle Name:OLATUNJI
Authorized Official - Last Name:OLAWUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-334-3451
Mailing Address - Street 1:7826 TERRI DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1478
Mailing Address - Country:US
Mailing Address - Phone:734-334-3451
Mailing Address - Fax:313-740-7338
Practice Address - Street 1:19272 GARFIELD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1313
Practice Address - Country:US
Practice Address - Phone:313-740-7338
Practice Address - Fax:313-740-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253J00000XAgenciesFoster Care Agency
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities