Organization
GRACE SENIOR LIVING, LLC
Active
Other names
Grace Manor
Organization subpart
No
Provider details
NPI number
Authorized official
LEONA JAMES RN MPH (ADMINISTRATOR)
(772) 812-8749
Entity
Organization
Contact information
Practice address
221 SW YAGER PL, PORT ST LUCIE, FL 34953-5468
(772) 812-8749
(772) 291-6304
Mailing address
221 SW YAGER PL, PORT ST LUCIE, FL 34953-5468
(772) 812-8749
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104232400
—
FL
Enumeration date
11/19/2021
Last updated
11/19/2021
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