Organization · Type 2 NPI

Graceworks Enhanced Living

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

NPI number 1972930659 Active

Practice location

1939 Kitty Hawk Dr
Xenia, OH 45385-5372

Call (513) 937-3762 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.

NPI record

NPI: 1972930659
Entity type: Organization (Type 2)
Issued: Sep 26, 2013
Last updated: Dec 23, 2020
Status: Active
Subpart: Yes of Graceworks Enhanced Living

Other names

<unavail>
Kitty Hawk · doing business as
Kitty Hawk · 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 1972930659

Graceworks Enhanced Living's National Provider Identifier is 1972930659, 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 Xenia, OH. The record was last updated on Dec 23, 2020.