Provider Demographics
NPI:1467214510
Name:INSPIRED GRACE HEALTHCARE INC
Entity Type:Organization
Organization Name:INSPIRED GRACE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:242-245-8912
Mailing Address - Street 1:1051 E MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2455
Mailing Address - Country:US
Mailing Address - Phone:224-245-8912
Mailing Address - Fax:
Practice Address - Street 1:1051 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2455
Practice Address - Country:US
Practice Address - Phone:224-245-8912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities