| Grace William Health Systems | |
|
714 Main Street Suite #200 Klamath Falls OR 97601-6074 | |
| (541) 880-6031 | |
| Not Available |
| Full Name | Grace William Health Systems |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 714 Main Street, Klamath Falls, Oregon |
| Authorized Official Name and Position | Olaoluwasupo Ojo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4438656503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace William Health Systems 714 Main Street Suite #200 Klamath Falls OR 97601-6074 Ph: (443) 865-6503 | Grace William Health Systems 714 Main Street Suite #200 Klamath Falls OR 97601-6074 Ph: (541) 880-6031 |
| NPI Number | 1659944783 |
|---|---|
| Provider Enumeration Date | 07/16/2021 |
| Last Update Date | 06/12/2023 |
| Certification Date | 06/12/2023 |
| Medicare PECOS PAC ID | 1759748403 |
|---|---|
| Medicare Enrollment ID | O20230612000983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659944783 | NPI | - | NPPES |
| 500805936 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Nimota R Bello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841766318 PECOS PAC ID: 5799016465 Enrollment ID: I20230630000734 |
| Provider Name | Folasade Adewunmi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699186676 PECOS PAC ID: 1153548110 Enrollment ID: I20230711001064 |
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