Organization
GRACE FRIENDSHIP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRIETTA G JACKSON (OWNER)
(954) 401-2806
Entity
Organization
Contact information
Practice address
4736 NW 5TH AVE, DEERFIELD BEACH, FL 33064-2563
(954) 401-2806
(954) 401-2806
Mailing address
2925 SW BOXWOOD CIR, PORT SAINT LUCIE, FL 34953-6966
(954) 401-2806
(954) 401-2806
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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