Provider Demographics
NPI:1295240042
Name:GRACE ADULT DAY CARE CENTER LLC
Entity type:Organization
Organization Name:GRACE ADULT DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YEONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:720-277-5116
Mailing Address - Street 1:2060 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1014
Mailing Address - Country:US
Mailing Address - Phone:303-750-0036
Mailing Address - Fax:
Practice Address - Street 1:2060 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1014
Practice Address - Country:US
Practice Address - Phone:303-750-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0185593163WA2000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty