Provider Demographics
NPI:1104327626
Name:GRACE EXCELLENCY CARE, LLC
Entity type:Organization
Organization Name:GRACE EXCELLENCY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:MODUPE
Authorized Official - Last Name:OLAGBEGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-313-1700
Mailing Address - Street 1:2066 MILLBURN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3722
Mailing Address - Country:US
Mailing Address - Phone:973-313-1700
Mailing Address - Fax:973-313-2300
Practice Address - Street 1:2066 MILLBURN AVE STE 102
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3722
Practice Address - Country:US
Practice Address - Phone:973-313-1700
Practice Address - Fax:973-313-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0200100251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services