Provider Demographics
NPI:1891511580
Name:THE GRACE SPACE
Entity type:Organization
Organization Name:THE GRACE SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SPARR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:402-770-9089
Mailing Address - Street 1:1740 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1502
Mailing Address - Country:US
Mailing Address - Phone:402-356-5885
Mailing Address - Fax:402-356-5884
Practice Address - Street 1:1740 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1502
Practice Address - Country:US
Practice Address - Phone:402-356-5885
Practice Address - Fax:402-356-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility