Organization · Type 2 NPI

Graceworks Enhanced Living

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

NPI number 1053748731 Active

Practice location

3690 Shakertown Rd
Beavercreek, OH 45430-1425

Call (937) 912-5127 Map

Fax (513) 612-6545

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.

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NPI record

NPI: 1053748731
Entity type: Organization (Type 2)
Issued: Sep 26, 2013
Last updated: Dec 23, 2020
Status: Active
Subpart: Yes of Graceworks Enhanced Living

Other names

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Shakertown · doing business as
Shakertown · doing business as

Authorized official

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

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1053748731

Graceworks Enhanced Living's National Provider Identifier is 1053748731, issued on Sep 26, 2013. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in Beavercreek, OH. The record was last updated on Dec 23, 2020.