Provider Demographics
NPI:1962243188
Name:GRACE COMMUNITY CARE LLC
Entity type:Organization
Organization Name:GRACE COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:KOUASSI
Authorized Official - Last Name:NOBOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-538-8528
Mailing Address - Street 1:712 MARIETTA PL NW APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3004
Mailing Address - Country:US
Mailing Address - Phone:203-583-9412
Mailing Address - Fax:203-549-9936
Practice Address - Street 1:712 MARIETTA PL NW APT 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3004
Practice Address - Country:US
Practice Address - Phone:203-583-9412
Practice Address - Fax:203-549-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities