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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