Provider Demographics
NPI:1205144391
Name:GRACE TLC ASSISTED LIVING LLC
Entity type:Organization
Organization Name:GRACE TLC ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYACINTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-386-7182
Mailing Address - Street 1:6622 CHIAPUK CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3150
Mailing Address - Country:US
Mailing Address - Phone:678-386-7182
Mailing Address - Fax:770-482-1609
Practice Address - Street 1:6622 CHIAPUK CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3150
Practice Address - Country:US
Practice Address - Phone:678-386-7182
Practice Address - Fax:770-482-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health