Provider Demographics
NPI:1568114676
Name:ANOINTING GRACE INC.
Entity Type:Organization
Organization Name:ANOINTING GRACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:727-560-6224
Mailing Address - Street 1:PO BOX 13751
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-3751
Mailing Address - Country:US
Mailing Address - Phone:727-490-9795
Mailing Address - Fax:727-864-1708
Practice Address - Street 1:2575 63RD AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-5247
Practice Address - Country:US
Practice Address - Phone:727-490-9795
Practice Address - Fax:727-864-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106103900Medicaid