Organization · Type 2 NPI

Graceworks Enhanced Living

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

NPI number 1265020697 Active

Practice location

612 Fredericksburg Dr
Dayton, OH 45415-2649

Call (937) 331-8141 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.

Other intellectual and/or developmental disabilities residential treatment facility providers in Dayton

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NPI record

NPI: 1265020697
Entity type: Organization (Type 2)
Issued: Dec 31, 2020
Last updated: Dec 31, 2020
Status: Active
Subpart: Yes of Graceworks Enhanced Living

Other names

Fredericksburg · 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 1265020697

Graceworks Enhanced Living's National Provider Identifier is 1265020697, issued on Dec 31, 2020. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in Dayton, OH. The record was last updated on Dec 31, 2020.