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Organization

C&G'S GRACE PLACE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LATESHA GASKIKNS (OWNER)
(813) 468-5303
Entity
Organization

Contact information

Practice address
6763 KRENSON OAKS CIR, LAKELAND, FL 33810-2157
(813) 468-5303
(863) 578-3659
Mailing address
6763 KRENSON OAKS CIR, LAKELAND, FL 33810-2157
(813) 468-5303
(863) 578-3659

Taxonomy

Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary

Other

Enumeration date
08/19/2019
Last updated
08/19/2019
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