Provider Demographics
NPI:1699148858
Name:GRACE ASSISTED LIVING INC
Entity type:Organization
Organization Name:GRACE ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERIHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKLEHAIMANOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-296-9909
Mailing Address - Street 1:20223 E 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7321
Mailing Address - Country:US
Mailing Address - Phone:720-296-9909
Mailing Address - Fax:
Practice Address - Street 1:20223 E 47TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-7321
Practice Address - Country:US
Practice Address - Phone:720-296-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care