Healthcare Provider Details

I. General information

NPI: 1144046772
Provider Name (Legal Business Name): EMERGING GRACE MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20397 RED OAK DR
CLEVELAND TX
77328-2956
US

IV. Provider business mailing address

27708 TOMBALL PKWY #125
TOMBALL TX
77375
US

V. Phone/Fax

Practice location:
  • Phone: 936-337-1103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GAETINA STAHL
Title or Position: CEO
Credential:
Phone: 936-337-1103