Provider Demographics
NPI:1861937443
Name:DAILY GRACE ADULT DAY HEALTH SERVICES, INC
Entity type:Organization
Organization Name:DAILY GRACE ADULT DAY HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EULANDA
Authorized Official - Middle Name:LARA
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:478-318-2313
Mailing Address - Street 1:868 GA-49
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211
Mailing Address - Country:US
Mailing Address - Phone:478-745-4700
Mailing Address - Fax:478-745-4900
Practice Address - Street 1:868 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211
Practice Address - Country:US
Practice Address - Phone:478-745-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000150311Z00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAADC000150OtherDEPARTMENT OF COMMUNITY HEALTH