Provider Demographics
NPI:1275864449
Name:GRACE HEALTH CLINIC
Entity Type:Organization
Organization Name:GRACE HEALTH CLINIC
Other - Org Name:GRACE HEALTH CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-755-4600
Mailing Address - Street 1:3191 S VAUGHN WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3505
Mailing Address - Country:US
Mailing Address - Phone:303-755-4600
Mailing Address - Fax:303-745-3884
Practice Address - Street 1:3191 S VAUGHN WAY STE 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3505
Practice Address - Country:US
Practice Address - Phone:303-755-4600
Practice Address - Fax:303-745-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 208000000X
CO261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42806046Medicaid