Grace Gardens, LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

2005031753 Issued in 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

Last updated

Mar 11, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anita F McCormack, MSW, LCSW

Title

Organizer

Phone

(314) 650-3281

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1299801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299801600000",
    "number": "1689972879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 REDWOOD LN",
            "city": "BOURBON",
            "state": "MO",
            "postal_code": "654417118",
            "telephone_number": "314-650-3281",
            "fax_number": "573-885-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 N FRANKLIN ST",
            "address_2": "STE 205",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "654531719",
            "telephone_number": "314-650-3281",
            "fax_number": "573-885-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE GARDENS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-11",
        "last_updated": "2011-03-11",
        "status": "A",
        "authorized_official_last_name": "MCCORMACK",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "314-650-3281",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MO",
            "license": "2005031753",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MO",
            "license": "2005031753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1891830477",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Donald James Fuchs, DDS
• Thomas L. Gibbon, DO
• Louis Edward Hagene, D.C.
• Sandy R Hagene, FNP
• Stacy Anne Hardwick, LPC
• Healthnet Regional Center of Cuba, Inc..
• John Wayne Hewkin, RPH.

• Adolescent and Children Mental Health Clinic/Center in Cuba, MO
• Providers in Cuba, MO by specialty
• Adolescent and Children Mental Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; 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.