Provider Demographics
NPI:1760868905
Name:SHERYL H GRACE
Entity Type:Organization
Organization Name:SHERYL H GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:HUGHEY
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-705-1763
Mailing Address - Street 1:180 THACKER RD
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9629
Mailing Address - Country:US
Mailing Address - Phone:336-705-1763
Mailing Address - Fax:
Practice Address - Street 1:180 THACKER RD
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9629
Practice Address - Country:US
Practice Address - Phone:336-705-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWS-2015-01252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency