Healthcare Provider Details

I. General information

NPI: 1720916323
Provider Name (Legal Business Name): GOD HOUSE OF GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 SPARROW LN
SAN JACINTO CA
92582-6970
US

IV. Provider business mailing address

496 SPARROW LN
SAN JACINTO CA
92582-6970
US

V. Phone/Fax

Practice location:
  • Phone: 901-900-0037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH WATTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 901-900-0037