Provider Demographics
NPI:1639769730
Name:T. GRACE BRANDS LLC
Entity Type:Organization
Organization Name:T. GRACE BRANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:704-431-4215
Mailing Address - Street 1:PO BOX 3294
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-3294
Mailing Address - Country:US
Mailing Address - Phone:704-431-4215
Mailing Address - Fax:
Practice Address - Street 1:125 E COUNCIL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5019
Practice Address - Country:US
Practice Address - Phone:704-431-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty