Southern Grace

NPI #1225643398 in Peyton, Colorado

Provider Information

NPI Number: 1225643398
Entity Type: Organization
Organization Name: Southern Grace
Primary Specialty: Foster Care Agency
Enumeration Date: Sep 14, 2020
Last Updated: Sep 14, 2020

Practice Location

Address: 11066 BIRCH HOLLOW WAY
City: Peyton
State: Colorado
ZIP Code: 80831-5036
Phone: (719) 459-9457

Authorized Official

Name: MR. CHRISTOPHER LAMONT BLOUNT
Title: CEO
Phone: (719) 459-9457

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Foster Care Agency	253J00000X	Primary

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