NPIMap

Organization Active NPI

Grace Senior Living, LLC

Doing business as Grace Manor

  • Assisted Living Facility
  • Port St Lucie, FL
National Provider Identifier
1629735030
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
GRACE SENIOR LIVING, LLC
Doing business as
Grace Manor
Practice address
221 SW Yager PL
Port St Lucie, FL 34953-5468
Phone
(772) 812-8749
Fax
(772) 291-6304
NPI assigned
Nov 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

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

Authorized official

Name
Leona James, RN MPHNPI 1679047716
Title
Administrator
Phone
(772) 812-8749

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

221 SW Yager PL
Port St Lucie, FL 34953-5468

Mailing address

221 SW Yager PL
Port St Lucie, FL 34953-5468
Phone (772) 812-8749

Other identifiers 1

IdentifierTypeStateIssuer
104232400MedicaidFL

Other names 1

  • Grace Manor Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL gracemanorpsl Direct

National Provider Directory

National Provider Directory
Tax ID family
Grace Senior Living4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637280000000",
    "number": "1629735030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 SW YAGER PL",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349535468",
            "telephone_number": "772-812-8749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 SW YAGER PL",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349535468",
            "telephone_number": "772-812-8749",
            "fax_number": "772-291-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "LEONA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-812-8749",
        "authorized_official_credential": "RN MPH"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104232400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "gracemanorpsl",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "221 SW Yager Pl",
            "city": "Port St Lucie",
            "state": "FL",
            "country_code": "US",
            "postal_code": "349535468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Grace Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.