| Gracious By Your Side Llc | |
|
35675 Garner St Romulus MI 48174-4129 | |
| (810) 308-7991 | |
| Not Available |
| Full Name | Gracious By Your Side Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 35675 Garner St, Romulus, Michigan |
| Authorized Official Name and Position | Shawna Dietrick (CEO) |
| Authorized Official Contact | 8103087991 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gracious By Your Side Llc Po Box 74083 Romulus MI 48174-0083 Ph: (810) 308-7991 | Gracious By Your Side Llc 35675 Garner St Romulus MI 48174-4129 Ph: (810) 308-7991 |
| NPI Number | 1346996287 |
|---|---|
| Provider Enumeration Date | 03/01/2022 |
| Last Update Date | 03/01/2022 |
| Certification Date | 03/01/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346996287 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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