Organization
GRACE ASSISTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACE H COOPER RN (OWNER/ADMINISTRATOR)
(941) 766-7178
Entity
Organization
Contact information
Practice address
22091 PEACHLAND BLVD, PORT CHARLOTTE, FL 33954-3352
(941) 766-7178
(941) 621-4975
Mailing address
16658 SAN EDMUNDO RD, PUNTA GORDA, FL 33955-4040
(646) 220-6106
(941) 621-4975
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12849
FL
3104A0625X
Assisted Living Facility (Mental Illness)
AL12849
FL
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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