Provider Demographics
NPI:1275211971
Name:GRACE ESTATES LLC
Entity Type:Organization
Organization Name:GRACE ESTATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-898-2053
Mailing Address - Street 1:801 NE VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9411
Mailing Address - Country:US
Mailing Address - Phone:515-415-4348
Mailing Address - Fax:515-864-0223
Practice Address - Street 1:801 NE VENTURE DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9411
Practice Address - Country:US
Practice Address - Phone:515-415-4348
Practice Address - Fax:515-864-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care