Organization · NPI-2

Grace Assisted Living, LLC

Assisted Living Facility · Port Charlotte, FL

NPI number1194177097
StatusActive
Last updated in NPPESJul 5, 2016

Details

NPI
1194177097
Entity type
Organization (NPI-2)
Legal business name
Grace Assisted Living, LLC
Organization subpart
No
Enumeration date
Jul 5, 2016
Last updated
Jul 5, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living FacilityAL12849FLYes
3104A0625X Assisted Living Facility, Assisted Living, Mental IllnessAL12849FL

Practice location

22091 Peachland Blvd
Port Charlotte, FL 33954-3352

Phone 941-766-7178 · Fax 941-621-4975

Mailing address

16658 San Edmundo Rd
Punta Gorda, FL 33955-4040

Phone 646-220-6106 · Fax 941-621-4975

Authorized official

Grace H Cooper
Owner/Administrator
9417667178

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