Healthcare Provider Details

I. General information

NPI: 1124827860
Provider Name (Legal Business Name): CHRISTIAN GRACE MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11875 PIGEON PASS RD # 1076
MORENO VALLEY CA
92557-6039
US

IV. Provider business mailing address

11875 PIGEON PASS RD # 1076
MORENO VALLEY CA
92557-6039
US

V. Phone/Fax

Practice location:
  • Phone: 800-355-4615
  • Fax:
Mailing address:
  • Phone: 800-355-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE FLOYD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 800-355-4615