Provider Demographics
NPI:1033980347
Name:G3 GRACE GRIT GROWTH LLC
Entity type:Organization
Organization Name:G3 GRACE GRIT GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EINING
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-PIP
Authorized Official - Phone:605-350-4812
Mailing Address - Street 1:226 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4149
Mailing Address - Country:US
Mailing Address - Phone:605-350-4812
Mailing Address - Fax:
Practice Address - Street 1:212 5TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2094
Practice Address - Country:US
Practice Address - Phone:605-350-4812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4723OtherBOARD OF SOCIAL WORK EXAMINERS