Provider Demographics
NPI:1689801169
Name:GRACE CHILDS FAMILY SERVICES
Entity Type:Organization
Organization Name:GRACE CHILDS FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GROVER
Authorized Official - Middle Name:BARRYTON
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-737-3205
Mailing Address - Street 1:301 MCCULLOUGH DR FL 4
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3310
Mailing Address - Country:US
Mailing Address - Phone:704-737-3205
Mailing Address - Fax:
Practice Address - Street 1:301 MCCULLOUGH DR FL 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3310
Practice Address - Country:US
Practice Address - Phone:704-737-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health