Organization
GRACE, COMMUNITY SUPPORTED LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GWEN PARR (CO-OWNER)
(608) 963-4357
Entity
Organization
Contact information
Practice address
4421 MORMON COULEE RD STE C, LA CROSSE, WI 54601-8220
(608) 963-4357
Mailing address
1815 REDFIELD ST, LA CROSSE, WI 54601-5862
(608) 963-4357
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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