Provider Demographics
NPI:1770443590
Name:GREATER GRACE GROUP HOME INCORPORATED
Entity type:Organization
Organization Name:GREATER GRACE GROUP HOME INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ABOSEDE
Authorized Official - Last Name:OLABODE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:256-348-5648
Mailing Address - Street 1:2809 FAIRCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8837
Mailing Address - Country:US
Mailing Address - Phone:704-441-8363
Mailing Address - Fax:
Practice Address - Street 1:2809 FAIRCROFT WAY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8837
Practice Address - Country:US
Practice Address - Phone:704-441-8363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-14
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Yes251S00000XAgenciesCommunity/Behavioral Health
No177F00000XOther Service ProvidersLodging
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities