Provider Demographics
NPI:1811172083
Name:GRACELYN GROUP, INC.
Entity type:Organization
Organization Name:GRACELYN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-432-5272
Mailing Address - Street 1:16862 INTERLACHEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5852
Mailing Address - Country:US
Mailing Address - Phone:952-432-5272
Mailing Address - Fax:952-236-0450
Practice Address - Street 1:16862 INTERLACHEN BLVD.
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5852
Practice Address - Country:US
Practice Address - Phone:952-432-5272
Practice Address - Fax:952-236-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1038810-2-WS251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services