Provider Demographics
NPI:1477214179
Name:MEGAL GRACE CARE LLC
Entity Type:Organization
Organization Name:MEGAL GRACE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:UZOMA
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:ONYEMAIZU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:313-854-8280
Mailing Address - Street 1:3250 BEECH DALY RD
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2676
Mailing Address - Country:US
Mailing Address - Phone:313-854-8280
Mailing Address - Fax:
Practice Address - Street 1:3250 BEECH DALY RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2676
Practice Address - Country:US
Practice Address - Phone:313-854-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20210802294741Medicaid