Provider Demographics
NPI:1831518927
Name:GRACE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:GRACE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-707-2071
Mailing Address - Street 1:169 DANIEL WEBSTER HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-5648
Mailing Address - Country:US
Mailing Address - Phone:603-707-2071
Mailing Address - Fax:
Practice Address - Street 1:169 DANIEL WEBSTER HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5648
Practice Address - Country:US
Practice Address - Phone:603-707-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0178224Z00000X
NH225100000X
NH0296225200000X
NH2410M225700000X
NH417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty