Provider Demographics
NPI:1821699091
Name:AW GRACE LLC
Entity Type:Organization
Organization Name:AW GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-673-1115
Mailing Address - Street 1:779 ROUTE 211 E STE 8
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1460
Mailing Address - Country:US
Mailing Address - Phone:845-673-1115
Mailing Address - Fax:
Practice Address - Street 1:779 ROUTE 211 E STE 8
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1460
Practice Address - Country:US
Practice Address - Phone:845-673-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care