Provider Demographics
NPI:1831756774
Name:GRACEANN CORP
Entity type:Organization
Organization Name:GRACEANN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-909-8908
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-0655
Mailing Address - Country:US
Mailing Address - Phone:718-909-8908
Mailing Address - Fax:718-471-9853
Practice Address - Street 1:15916 UNION TPKE
Practice Address - Street 2:STE 325
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1963
Practice Address - Country:US
Practice Address - Phone:718-909-8908
Practice Address - Fax:718-471-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty