Organization · Type 2 NPI

Graceworks Enhanced Living

Intellectual and/or Developmental Disabilities Residential Treatment Facility · West Carrollton, OH

NPI number 1003403155 Active

Practice location

204 W Main St
West Carrollton, OH 45449-1424

Call (937) 530-8042 Map

Mailing address

11370 Springfield Pike
Cincinnati, OH 45246-4202

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary	320600000X	None listed

Intellectual and/or Developmental Disabilities Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

NPI record

NPI: 1003403155
Entity type: Organization (Type 2)
Issued: Dec 23, 2020
Last updated: Dec 23, 2020
Status: Active
Subpart: Yes of Graceworks Enhanced Living

Other names

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West Main · doing business as

Authorized official

Mr. Michael W. Allen
Vice President, Finance & Facilitie
(937) 436-6885

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About NPI 1003403155

Graceworks Enhanced Living's National Provider Identifier is 1003403155, issued on Dec 23, 2020. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in West Carrollton, OH. The record was last updated on Dec 23, 2020.