Provider Demographics
NPI:1609333830
Name:HOUSE OF GRACE LLC
Entity Type:Organization
Organization Name:HOUSE OF GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ONYINYECHI
Authorized Official - Last Name:URADU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-939-8486
Mailing Address - Street 1:401 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-2708
Mailing Address - Country:US
Mailing Address - Phone:606-939-8486
Mailing Address - Fax:
Practice Address - Street 1:401 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2708
Practice Address - Country:US
Practice Address - Phone:606-939-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty