Provider Demographics
NPI:1528204955
Name:SOUTHERN GRACES
Entity Type:Organization
Organization Name:SOUTHERN GRACES
Other - Org Name:PATRICIA'S RESIDENTIAL CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-223-4689
Mailing Address - Street 1:220 ECKLES ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-1012
Mailing Address - Country:US
Mailing Address - Phone:573-223-4689
Mailing Address - Fax:573-223-4689
Practice Address - Street 1:220 ECKLES ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-1012
Practice Address - Country:US
Practice Address - Phone:573-223-4689
Practice Address - Fax:573-223-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO311ZA0620X311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home