Provider Demographics
NPI:1982440962
Name:THY GRACE CARE LLC
Entity type:Organization
Organization Name:THY GRACE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-432-4351
Mailing Address - Street 1:36019 W SAN CLEMENTE AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2118
Mailing Address - Country:US
Mailing Address - Phone:614-432-4351
Mailing Address - Fax:
Practice Address - Street 1:37728 W SAN CAPISTRANO AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5422
Practice Address - Country:US
Practice Address - Phone:614-432-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THY GRACE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-08
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness