Provider Demographics
NPI:1124879572
Name:SOUL GRACE COACHING CO,
Entity type:Organization
Organization Name:SOUL GRACE COACHING CO,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:586-339-2178
Mailing Address - Street 1:27378 PARKVIEW BLVD APT 4314
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3501
Mailing Address - Country:US
Mailing Address - Phone:586-339-2178
Mailing Address - Fax:
Practice Address - Street 1:4000 TOWN CTR STE 1350
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1427
Practice Address - Country:US
Practice Address - Phone:586-339-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No342000000XTransportation ServicesTransportation Network Company
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)