Organization
GRACE COMMUNITY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANI ALYCE BROWN RN (ADMINISTRATOR/CEO)
(478) 747-9329
Entity
Organization
Contact information
Practice address
2402 ANTHONY TER, MACON, GA 31206-3120
(478) 788-9706
(347) 710-9329
Mailing address
1495 WESTMINISTER DR, MACON, GA 31204-4844
(478) 254-4129
(347) 710-9329
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
011-01-114-1
GA
311ZA0620X
Adult Care Home Facility
Primary
011-01-114-1
GA
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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