Organization
DIVINE GRACE COUNTRY HOME LLC.
Active
Other names
Divine Grace Country Home
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MARIE OTT (MEMBER/OWNER)
(269) 449-4285
Entity
Organization
Contact information
Practice address
7720 WRIGHT RD, NILES, MI 49120-9071
(269) 449-4285
Mailing address
PO BOX 243, BARODA, MI 49101-0243
(269) 449-4285
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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