| House of Graces LLC | |
|
4260 N 19th Ave Phoenix AZ 85015-5108 | |
| (775) 379-3850 | |
| Not Available |
| Full Name | House of Graces LLC |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4260 N 19th Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Samantha D Owens (OWNER) |
| Authorized Official Contact | 7753793850 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| House of Graces LLC 4260 N 19th Ave Phoenix AZ 85015-5108 Ph: (775) 379-3850 | House of Graces LLC 4260 N 19th Ave Phoenix AZ 85015-5108 Ph: (775) 379-3850 |
| NPI Number | 1073106373 |
|---|---|
| Provider Enumeration Date | 02/17/2021 |
| Last Update Date | 03/12/2021 |
| Certification Date | 03/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073106373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | () | Primary |
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