Provider Demographics
NPI:1891542759
Name:RAY OF GRACE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:RAY OF GRACE HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL-CLEOPHAT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-208-2229
Mailing Address - Street 1:9821 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1064
Mailing Address - Country:US
Mailing Address - Phone:786-208-2229
Mailing Address - Fax:
Practice Address - Street 1:9821 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1064
Practice Address - Country:US
Practice Address - Phone:786-208-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty