Provider Demographics
NPI:1568805307
Name:GRACE HEALTHCARE LLC
Entity Type:Organization
Organization Name:GRACE HEALTHCARE LLC
Other - Org Name:GRACE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:KACEY
Authorized Official - Middle Name:KNEECE
Authorized Official - Last Name:REEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-271-6334
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0476
Mailing Address - Country:US
Mailing Address - Phone:803-321-2499
Mailing Address - Fax:803-321-2585
Practice Address - Street 1:2562 KINARD ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2910
Practice Address - Country:US
Practice Address - Phone:803-321-2499
Practice Address - Fax:803-321-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCM-33196261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care