Provider Demographics
NPI:1497399802
Name:GRACES COMMUNITY HEALTHCARE INC
Entity Type:Organization
Organization Name:GRACES COMMUNITY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NDOFUNSU
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-394-3033
Mailing Address - Street 1:2905 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3857
Mailing Address - Country:US
Mailing Address - Phone:704-394-3033
Mailing Address - Fax:
Practice Address - Street 1:2905 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3857
Practice Address - Country:US
Practice Address - Phone:704-394-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health