Provider Demographics
NPI:1629720313
Name:TOUCH OF GRACE ASSISTING LIVING FACILITY, INC
Entity Type:Organization
Organization Name:TOUCH OF GRACE ASSISTING LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GASNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALADIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-943-2579
Mailing Address - Street 1:3425 SW RIVERA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3763
Mailing Address - Country:US
Mailing Address - Phone:516-943-2579
Mailing Address - Fax:772-877-2914
Practice Address - Street 1:3425 SW RIVERA ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3763
Practice Address - Country:US
Practice Address - Phone:516-943-2579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOUCH OF GRACE ASSISTING LIVING FACILITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-24
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness