Organization
AMAZING GRACE TREATMENT CENTER THERAPEUTIC CARE, LLC.
Active
Organization
AMAZING GRACE TREATMENT CENTER THERAPEUTIC CARE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TYES'A NELLOMS QMHS, ADN (PROGRAM MANAGER)
(937) 231-8773
Entity
Organization
Contact information
Practice address
17 INDIANA AVE, DAYTON, OH 45410-2307
(937) 231-8773
Mailing address
330 W 1ST ST APT 905, DAYTON, OH 45402-3055
(937) 231-8773
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/06/2026
Last updated
04/06/2026
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