Organization
HOUSE OF G.R.A.C.E.RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDRA MARTIN PHD , LISW-S (CEO)
(330) 915-8347
Entity
Organization
Contact information
Practice address
116 CLEVELAND AVE NW STE 555, SUITE 555, CANTON, OH 44702-1779
(330) 915-8347
(330) 915-6030
Mailing address
116 CLEVELAND AVE NW, SUITE 555, CANTON, OH 44702-1779
(330) 915-8347
(330) 915-6030
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0215619
—
OH
01
—
7610455
OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES
OH
Enumeration date
05/06/2020
Last updated
11/17/2021
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