| Awaken Grace Llc | |
|
36 Kirkham Industrial Dr Ste 100 Webster Groves MO 63119-1754 | |
| (314) 578-3551 | |
| Not Available |
| Full Name | Awaken Grace Llc |
|---|---|
| Speciality | Social Worker |
| Location | 36 Kirkham Industrial Dr Ste 100, Webster Groves, Missouri |
| Authorized Official Name and Position | Allison A Grace (MANAGER/ SOLE PROPRIETOR) |
| Authorized Official Contact | 3145783551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken Grace Llc 1347 Culpepper Ridge Dr Ballwin MO 63021-7526 Ph: (314) 578-3551 | Awaken Grace Llc 36 Kirkham Industrial Dr Ste 100 Webster Groves MO 63119-1754 Ph: (314) 578-3551 |
| NPI Number | 1275052599 |
|---|---|
| Provider Enumeration Date | 09/18/2017 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 7012277510 |
|---|---|
| Medicare Enrollment ID | O20220504000818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275052599 | NPI | - | NPPES |
| 1629451737 | Other | MO | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149018867 (Illinois) | Secondary |
| 1041C0700X | Social Worker - Clinical | 003113 (Missouri) | Primary |
| Provider Name | Allison Anne Grace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629451737 PECOS PAC ID: 6901181627 Enrollment ID: I20220504000880 |
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