Southern Grace

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

Legal business name

SOUTHERN GRACE

Practice address

11066 Birch Hollow Way
Peyton, CO 80831-5036

Phone

(719) 459-9457

NPI assigned

Sep 14, 2020

Last updated

Sep 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Christopher Lamont Blount

Title

Ceo

Phone

(719) 459-9457

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1225643398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11066 BIRCH HOLLOW WAY",
            "city": "PEYTON",
            "state": "CO",
            "postal_code": "808315036",
            "telephone_number": "719-459-9457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11066 BIRCH HOLLOW WAY",
            "city": "PEYTON",
            "state": "CO",
            "postal_code": "808315036",
            "telephone_number": "719-459-9457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-14",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A",
        "authorized_official_last_name": "BLOUNT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-459-9457",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.