Organization
HOUSE OF GRACES LLC
Active
Parent organization
HOUSE OF GRACES LLC
Other names
House of graces LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOUSE OF GRACES LLC
Authorized official
SAMANTHA D OWENS (OWNER)
(775) 379-3850
Entity
Organization
Contact information
Practice address
4260 N 19TH AVE, PHOENIX, AZ 85015-5108
(775) 379-3850
Mailing address
4260 N 19TH AVE, PHOENIX, AZ 85015-5108
(775) 379-3850
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/17/2021
Last updated
03/12/2021
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