Provider Demographics
NPI:1942852561
Name:GRACE COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:GRACE COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANTAHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-646-6281
Mailing Address - Street 1:24238 E ARAPAHOE PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4138
Mailing Address - Country:US
Mailing Address - Phone:720-646-6281
Mailing Address - Fax:
Practice Address - Street 1:24238 E ARAPAHOE PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4138
Practice Address - Country:US
Practice Address - Phone:720-646-6281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities