# LADY GRACE STORES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679700991
- **Authorized official:** MR. BRUCE I GREEN (TREASURER)
- **Authorized official phone:** (781) 322-1721

## Contact information

- **Practice address:** 790 IYANNOUGH RD, HYANNIS, MA 02601-4916
- **Practice address phone:** (508) 771-3608
- **Mailing address:** 790 IYANNOUGH RD, HYANNIS, MA 02601-4916
- **Mailing address phone:** (508) 771-3608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335E00000X | Prosthetic/Orthotic Supplier | — | MA | Yes |

## Other

- **Enumeration date:** 06/12/2009
- **Last updated:** 06/12/2009