Healthcare Provider Details

I. General information

NPI: 1588147037
Provider Name (Legal Business Name): GRACE HOUSE MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S HARRISON ST
SHELBYVILLE IN
46176-2101
US

IV. Provider business mailing address

703 S HARRISON ST
SHELBYVILLE IN
46176-2101
US

V. Phone/Fax

Practice location:
  • Phone: 317-398-6697
  • Fax:
Mailing address:
  • Phone: 317-398-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: GREG PARKS
Title or Position: OWNER
Credential:
Phone: 317-398-6697