Provider Demographics
NPI:1528504495
Name:GRACE AGING SERVICES LLC
Entity type:Organization
Organization Name:GRACE AGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUFTS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-870-8158
Mailing Address - Street 1:142 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5985
Mailing Address - Country:US
Mailing Address - Phone:978-870-8158
Mailing Address - Fax:
Practice Address - Street 1:142 RICHARD RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5985
Practice Address - Country:US
Practice Address - Phone:978-870-8158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119558251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health