Provider Demographics
NPI:1548807142
Name:MOTHER OF GRACE LLC
Entity type:Organization
Organization Name:MOTHER OF GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ONUAWUCHI
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-560-6541
Mailing Address - Street 1:7947 TULANE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2321
Mailing Address - Country:US
Mailing Address - Phone:231-715-2383
Mailing Address - Fax:
Practice Address - Street 1:7947 TULANE ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2321
Practice Address - Country:US
Practice Address - Phone:231-715-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness