NPIMap

Organization Active NPI

House of G.R.a.C.E.Residential Services, LLC

  • Home Health Agency
  • Canton, OH
National Provider Identifier
1235750753
Registry record updated Nov 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HOUSE OF G.R.A.C.E.RESIDENTIAL SERVICES, LLC
Practice address
116 Cleveland Ave NW Ste 555
Suite 555
Canton, OH 44702-1779
Phone
(330) 915-8347
Fax
(330) 915-6030
NPI assigned
May 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2021

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

Authorized official

Name
Audra Martin, PHD , LISW-SNPI 1184443996
Title
Ceo
Phone
(330) 915-8347

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Developmental Disabilities Clinic/Center 261QD1600X

Addresses

Primary practice location

116 Cleveland Ave NW Ste 555
Suite 555
Canton, OH 44702-1779

Mailing address

116 Cleveland Ave NW
Suite 555
Canton, OH 44702-1779
Phone (330) 915-8347

Other identifiers 2

IdentifierTypeStateIssuer
7610455OtherOHOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES
0215619MedicaidOH

National Provider Directory

National Provider Directory

Locations

2800 Market Ave N
Ste 26
Canton, OH 44714

116 Cleveland Ave NW
Ste 555
Canton, OH 44702
Phone (330) 915-8347

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637107200000",
    "number": "1235750753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 CLEVELAND AVE NW",
            "address_2": "SUITE 555",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021779",
            "telephone_number": "330-915-8347",
            "fax_number": "330-915-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 CLEVELAND AVE NW STE 555",
            "address_2": "SUITE 555",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021779",
            "telephone_number": "330-915-8347",
            "fax_number": "330-915-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSE OF G.R.A.C.E.RESIDENTIAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-06",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "AUDRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-915-8347",
        "authorized_official_credential": "PHD , LISW-S"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES",
            "identifier": "7610455",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0215619",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; 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.