Organization
GRACE HOME LIVING FACILITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COLLETTE KATRELL HOLMES (ADMINISTRATOR)
(904) 673-7212
Entity
Organization
Contact information
Practice address
2821 HUNT ST, JACKSONVILLE, FL 32254-4003
(904) 379-6710
Mailing address
2821 HUNT ST, JACKSONVILLE, FL 32254-4003
(904) 379-6710
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12677
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015058700
—
FL
Enumeration date
09/18/2015
Last updated
09/18/2015
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