Provider Demographics
NPI:1528184959
Name:GRACE OF SERENITY LIVING, INC
Entity Type:Organization
Organization Name:GRACE OF SERENITY LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-441-4690
Mailing Address - Street 1:4620 N 16TH ST
Mailing Address - Street 2:A-101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5121
Mailing Address - Country:US
Mailing Address - Phone:602-441-4690
Mailing Address - Fax:602-441-4694
Practice Address - Street 1:4620 N 16TH ST
Practice Address - Street 2:A-101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5121
Practice Address - Country:US
Practice Address - Phone:602-441-4690
Practice Address - Fax:602-441-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3929251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ931271Other2