HOUSE OF G.R.A.C.E.RESIDENTIAL SERVICES, LLC (NPI# 1235750753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235750753 |
| Entity Type | Organization |
| Organization Name | HOUSE OF G.R.A.C.E.RESIDENTIAL SERVICES, LLC |
| Practice Address |
2800 Market Ave N Ste 26 Canton OH 44714-1779 |
| Practice Telephone | 3302244158 |
| Practice Fax Number | 3309156030 |
| Mailing Telephone | 3302244158 |
| Mailing Fax Number | 3309156030 |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-07-09 |
| Authorized Official Name | AUDRA MARTIN (CEO) |
| Authorized Official Telephone | 3302244158 |
| Authorized Official Credential | PHD, LISW-S |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251E00000X | Home Health | Agencies | ||
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0215619 | 05 | |
| OH | OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES | 7610455 | 01 |
| Street Address |
2800 MARKET AVE N STE 26 |
| City | CANTON |
| State | OH |
| Zip Code | 44714-1779 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164941365 | Desiree Morgan | Occupational Therapy Assistant | 1634 20th St. N.e., Canton, OH 44714 | 2017-09-19 |
| 1932525706 | Cody Henninge | In Home Supportive Care | 2800 Market Ave N Suite 16, Canton, OH 44714 | 2014-03-17 |
| 1346584984 | Quest Recovery and Prevention Services | Substance Abuse Rehabilitation Facility | 1711 Spring Avenue Nw, Canton, OH 44714 | 2012-11-20 |
| 1780159921 | Lynne Marie Shayko | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2018-10-03 |
| 1427437540 | Robert D Cox | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2015-05-21 |
| 1316336878 | Erika D Putnam | Counselor | 1711 Spring Ave Ne, Canton, OH 44714 | 2015-01-21 |
| 1225435969 | Emily A Custer | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2014-11-24 |
| 1700438363 | Ryan Gernert | Specialist/Technologist | 5323 Gardendale Ave Ne, Canton, OH 44714-1042 | 2019-07-14 |
| 1982171468 | Adrienne Chavers | Home Health | 5438 Market Ave N, Canton, OH 44714-1059 | 2018-11-01 |
| 1912061797 | Living 4 Independence | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4629 Helmsworth Dr Ne, Canton, OH 44714-1162 | 2006-12-19 |
| Find all providers in zip 44714 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417289489 | Iccd Partners, LLP | Clinic/Center | 340 Turnpike St, Canton, MA 02021-2700 | 2010-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689275125 | Amy Joy Knott | Clinic/Center | 761 N Freedom St, Ravenna, OH 44266-2470 | 2020-11-02 |
| 1063010676 | Melinda Annette Green | Clinic/Center | 22 Meadowbrook Ave, Boardman, OH 44512-2605 | 2020-10-15 |
| 1316404965 | Joyful Living Care | Clinic/Center | 4209 Secor Rd Apt 339, Toledo, OH 43623-4222 | 2019-03-01 |
| 1952881237 | Hh Direct Health Services LLC. | Clinic/Center | 14920 Grandview Ter, East Cleveland, OH 44112-2940 | 2018-08-16 |
| 1104367218 | Derek Engler | Clinic/Center | 1012 Mavor St, Springfield, OH 45505-2848 | 2017-03-09 |
| 1295166031 | Abc Therapy Ltd | Clinic/Center | 30 Rothrock Loop, Copley, OH 44321-1331 | 2013-12-04 |
| 1275813602 | Liberty Care Agency, LLC | Clinic/Center | 5210 Aster Park Dr Apt 1712, Hamilton, OH 45011-6300 | 2011-08-17 |
| 1215101811 | Beth Rosner, Ph.d. LLC | Clinic/Center | 7644 Slate Ridge Blvd, Reynoldsburg, OH 43068-8159 | 2008-04-15 |
| 1194852749 | Brown County Board of Mental Retardation and Developmental Disabilitie | Clinic/Center | 325 W State St, Building A, Suite 2, Georgetown, OH 45121-1229 | 2007-02-28 |
| 1265578348 | Sara's Garden-the Sara Joy Rychener-burkholder Hyperbaric Center | Clinic/Center | 620 W Leggett St, Wauseon, OH 43567-1348 | 2007-01-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.