Grace Home Living Facility LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12677 Issued in FL

Legal business name

GRACE HOME LIVING FACILITY LLC

Practice address

2821 Hunt St
Jacksonville, FL 32254-4003

Phone

(904) 379-6710

NPI assigned

Sep 18, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Collette Katrell HolmesNPI 1932577970

Title

Administrator

Phone

(904) 673-7212

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Collette Katrell Holmes

  • Mental Illness Community Based Residential Treatment Facility
  • Jacksonville, FL
  • NPI 1932577970
  NPD Authorized official

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1467821512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 HUNT ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322544003",
            "telephone_number": "904-379-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 HUNT ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322544003",
            "telephone_number": "904-379-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HOME LIVING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "COLLETTE",
        "authorized_official_middle_name": "KATRELL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-673-7212",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015058700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amalia V Gozum, MD
• Emily Rose Grabowski
• Grace & Mercy Homecare LLC
• Grace B Dorado-Foster Doctor of Optometry Professional Association
• Grace Christian Counseling
• Grace Medical Services LLC
• Grace Solutions LLC (Beautiful Life Care & Services)
• Grace Spine LLC
• Sara Elizabeth Grace, BSRT
• Grace's Senior Care Services

• Assisted Living Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; 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.