Provider Demographics
NPI:1134160534
Name:GRACE HEALTH, INC.
Entity type:Organization
Organization Name:GRACE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-965-8866
Mailing Address - Street 1:181 W EMMETT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2963
Mailing Address - Country:US
Mailing Address - Phone:269-965-8866
Mailing Address - Fax:269-965-4773
Practice Address - Street 1:115 MARKET PL
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1767
Practice Address - Country:US
Practice Address - Phone:517-629-6540
Practice Address - Fax:517-629-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A36090OtherMEDICARE GROUP NUMBER
231885OtherMEDICARE LOCATION NUMBER
MI700A311700OtherBLUE CROSS BLUE SHIELD