Provider Demographics
NPI:1295068757
Name:GRACE HILL NEIGHBORHOOD HEALTH CTR
Entity type:Organization
Organization Name:GRACE HILL NEIGHBORHOOD HEALTH CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-814-8556
Mailing Address - Street 1:2220 LEMP AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2700
Mailing Address - Country:US
Mailing Address - Phone:314-814-8556
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:2220 LEMP AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2700
Practice Address - Country:US
Practice Address - Phone:314-814-8556
Practice Address - Fax:314-814-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
MO2009014930133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty