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Organization
DIVINE GRACE COUNTRY HOME LLC.
Active
Organization
DIVINE GRACE COUNTRY HOME LLC.
Active
Other names
Divine Grace Country Home
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MARIE OTT (MEMBER/OWNER)
(269) 449-4285
Entity
Organization
Contact information
Practice address
7720 WRIGHT RD, NILES, MI 49120-9071
(269) 449-4285
Mailing address
PO BOX 243, BARODA, MI 49101-0243
(269) 449-4285
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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