Provider Demographics
NPI:1114522273
Name:HEALING GRACE, LLC
Entity type:Organization
Organization Name:HEALING GRACE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:763-260-3347
Mailing Address - Street 1:17641 COUNTY ROAD 66 NE
Mailing Address - Street 2:
Mailing Address - City:MILTONA
Mailing Address - State:MN
Mailing Address - Zip Code:56354-8272
Mailing Address - Country:US
Mailing Address - Phone:763-260-3347
Mailing Address - Fax:
Practice Address - Street 1:310 US 71 N
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-4919
Practice Address - Country:US
Practice Address - Phone:320-272-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty