Provider Demographics
NPI:1710659008
Name:GRACE HEALTH CARE CENTER PLLC
Entity Type:Organization
Organization Name:GRACE HEALTH CARE CENTER PLLC
Other - Org Name:GRACE HEALTH & URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINENYE
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHENDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-7272
Mailing Address - Street 1:8610 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-1943
Mailing Address - Country:US
Mailing Address - Phone:919-803-6799
Mailing Address - Fax:
Practice Address - Street 1:8610 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-1943
Practice Address - Country:US
Practice Address - Phone:919-803-6799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization