Provider Demographics
NPI:1184138851
Name:MY GRACE IS SUFFICIENT
Entity type:Organization
Organization Name:MY GRACE IS SUFFICIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRASTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-510-9969
Mailing Address - Street 1:815 S ANGLIM AVE
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-3551
Mailing Address - Country:US
Mailing Address - Phone:231-510-9969
Mailing Address - Fax:863-452-0069
Practice Address - Street 1:3425 HEALEY ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-3142
Practice Address - Country:US
Practice Address - Phone:231-510-9969
Practice Address - Fax:863-452-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities