Provider Demographics
NPI:1861233207
Name:GRACE CARE HOMES INC.
Entity type:Organization
Organization Name:GRACE CARE HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:LEMOTT
Authorized Official - Last Name:JEMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-999-0404
Mailing Address - Street 1:PO BOX 5418
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0418
Mailing Address - Country:US
Mailing Address - Phone:503-999-0404
Mailing Address - Fax:
Practice Address - Street 1:1205 BARNES AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1539
Practice Address - Country:US
Practice Address - Phone:503-391-4881
Practice Address - Fax:888-234-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness