| Organization Name: | GRACE SERVICES, LLC |
| NPI Number: | 1013336627 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GORDON E COBURN (OWNER) |
| Mailing Address: | 2 Worth Cir Suite 2 Johnson City |
| State: | TN US |
| Postal Code: | 376014306 |
| Phone Number: | 4232834958 |
| Fax Number: | 4232837135 |
| NPI Enumeration Date: | 04/10/2014 |
| NPI Last Update Date: | 04/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 11054 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |