Provider Demographics
NPI:1407170392
Name:GRACE PCH CARING HAND, INC.
Entity Type:Organization
Organization Name:GRACE PCH CARING HAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKIVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-463-5695
Mailing Address - Street 1:675 BRAND SOUTH TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 BRAND SOUTH TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8865
Practice Address - Country:US
Practice Address - Phone:678-463-5695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-21
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA451656787AMedicaid