NPIMap

Organization Active NPI

Graceworks Enhanced Living

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Dayton, OH
National Provider Identifier
1265020697
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
GRACEWORKS ENHANCED LIVING
Doing business as
Fredericksburg
Practice address
612 Fredericksburg Dr
Dayton, OH 45415-2649
Phone
(937) 331-8141
NPI assigned
Dec 31, 2020
Organization subpart
Yes
Parent organization
GRACEWORKS ENHANCED LIVINGAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Authorized official

Name
Mr. Michael W Allen
Title
Vice President, Finance & Facilitie
Phone
(937) 436-6885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

612 Fredericksburg Dr
Dayton, OH 45415-2649

Mailing address

11370 Springfield Pike
Cincinnati, OH 45246-4202

Other names 1

  • Fredericksburg Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Graceworks Enhanced Living46 organizations share this tax ID, including this one
Part of
Graceworks Enhanced Living

Other organizations with this tax ID 45

Organizations that report the same tax identification number in the National Provider Directory.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1265020697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11370 SPRINGFIELD PIKE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452464202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 FREDERICKSBURG DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454152649",
            "telephone_number": "937-331-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEWORKS ENHANCED LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACEWORKS ENHANCED LIVING",
        "enumeration_date": "2020-12-31",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-23",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VICE PRESIDENT, FINANCE & FACILITIE",
        "authorized_official_telephone_number": "937-436-6885",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fredericksburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.