Provider Demographics
NPI:1851058135
Name:GRACE EXCELLENCY CARE
Entity Type:Organization
Organization Name:GRACE EXCELLENCY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:MODUPE
Authorized Official - Last Name:OLAGBEGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-313-1700
Mailing Address - Street 1:2066 MILLBURN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3722
Mailing Address - Country:US
Mailing Address - Phone:973-313-1700
Mailing Address - Fax:973-313-2300
Practice Address - Street 1:837 VALLEY ST APT C
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1257
Practice Address - Country:US
Practice Address - Phone:973-313-1700
Practice Address - Fax:973-313-2300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE EXCELLENCY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities