Healthcare Provider Details

I. General information

NPI: 1033201611
Provider Name (Legal Business Name): GRACEWORKS LUTHERAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 FAR HILLS AVE
DAYTON OH
45459-2725
US

IV. Provider business mailing address

6451 FAR HILLS AVE
DAYTON OH
45459-2725
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-2110
  • Fax:
Mailing address:
  • Phone: 937-433-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0632N
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT A REICHARD
Title or Position: VICE PRESIDENT, FINANCE
Credential: CPA
Phone: 937-436-6865