Provider Demographics
NPI:1780441386
Name:GRACE GROUP HOMES, LLC
Entity type:Organization
Organization Name:GRACE GROUP HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:DUGUE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:518-469-2129
Mailing Address - Street 1:633 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-2380
Mailing Address - Country:US
Mailing Address - Phone:518-469-2129
Mailing Address - Fax:
Practice Address - Street 1:633 GRACE ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2380
Practice Address - Country:US
Practice Address - Phone:518-469-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251J00000XAgenciesNursing Care