Provider Demographics
NPI:1891501383
Name:BY GRACE RECOVERY HOMES LLC
Entity type:Organization
Organization Name:BY GRACE RECOVERY HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-544-5902
Mailing Address - Street 1:1819 OAKLEY CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1819 OAKLEY CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-6357
Practice Address - Country:US
Practice Address - Phone:913-544-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No177F00000XOther Service ProvidersLodging