| Grace Family Care Llc | |
|
920 E Madison St Ste 100 Phoenix AZ 85034-2225 | |
| (480) 272-7723 | |
| Not Available |
| Full Name | Grace Family Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 920 E Madison St Ste 100, Phoenix, Arizona |
| Authorized Official Name and Position | Lawrence Thomas (ADMINISTRATOR) |
| Authorized Official Contact | 4804908803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Family Care Llc 920 E Madison St Ste 100 Phoenix AZ 85034-2225 Ph: (480) 272-7723 | Grace Family Care Llc 920 E Madison St Ste 100 Phoenix AZ 85034-2225 Ph: (480) 272-7723 |
| NPI Number | 1902661457 |
|---|---|
| Provider Enumeration Date | 02/14/2024 |
| Last Update Date | 08/22/2024 |
| Certification Date | 08/22/2024 |
| Medicare PECOS PAC ID | 9032558366 |
|---|---|
| Medicare Enrollment ID | O20240418002713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902661457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Elizabeth A Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932731395 PECOS PAC ID: 0244660173 Enrollment ID: I20200416003972 |
| Provider Name | Daud Biola Koleosho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962093781 PECOS PAC ID: 4880001544 Enrollment ID: I20210324001387 |
| Provider Name | Lawrence Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427452242 PECOS PAC ID: 8123412350 Enrollment ID: I20220303001267 |
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