Provider Demographics
NPI:1023722865
Name:GRACE COMMUNITY CARE SERVICES, LLC
Entity type:Organization
Organization Name:GRACE COMMUNITY CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NARISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUNTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:336-396-3005
Mailing Address - Street 1:8025 N POINT BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3262
Mailing Address - Country:US
Mailing Address - Phone:336-396-3005
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD STE 123
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3262
Practice Address - Country:US
Practice Address - Phone:336-396-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health