Provider Demographics
NPI:1013336627
Name:GRACE SERVICES, LLC
Entity Type:Organization
Organization Name:GRACE SERVICES, LLC
Other - Org Name:GRACE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:E
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:423-283-4958
Mailing Address - Street 1:2 WORTH CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4306
Mailing Address - Country:US
Mailing Address - Phone:423-283-4958
Mailing Address - Fax:423-283-7135
Practice Address - Street 1:2 WORTH CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4306
Practice Address - Country:US
Practice Address - Phone:423-283-4958
Practice Address - Fax:423-283-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11054163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty