Grace Gardens, LLC
Organization Active NPI Adolescent and Children Mental Health Clinic/Center · Cuba, MO
NPI 1689972879 · NPPES record last updated Mar 11, 2011
Key facts
- NPI
- 1689972879
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adolescent and Children Mental Health Clinic/Center 261QM0855X
- License
- 2005031753 (MO)
- Legal business name
- GRACE GARDENS, LLC
- Practice address
- 412 N Franklin St
Ste 205
Cuba, MO 65453-1719 - Phone
- (314) 650-3281
- Fax
- (573) 885-1600
- NPI assigned
- Mar 11, 2011
- Organization subpart
- No
Authorized official
- Name
- Anita F McCormack, MSW, LCSW
- Title
- Organizer
- Phone
- (314) 650-3281
National Provider Directory
Locations
412 N Franklin St
Ste 205
Cuba, MO 65453
Phone (314) 650-3281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Mental Health Clinic/Center | 261QM0850X | 2005031753 | MO | |
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | 2005031753 | MO | Yes |
Addresses
Primary practice location
412 N Franklin St
Ste 205
Cuba, MO 65453-1719
Mailing address
130 Redwood LN
Bourbon, MO 65441-7118
Phone (314) 650-3281
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891830477 | Other | MO | INDIVIDUAL NPI |
Other providers in Cuba, MO
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- Shayla M Farris
- Susan Marie Frago
- Donald James Fuchs
- Thomas L. Gibbon
- Louis Edward Hagene
- Sandy R Hagene
- Stacy Anne Hardwick
- Healthnet Regional Center of Cuba, Inc..
- John Wayne Hewkin
All providers in Cuba, MO · Adolescent and Children Mental Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.