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General NPI Number Information
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NPI Number | 1164615951
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Entity Type | Organization
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Legal Business Name | GRACE CHURCH COMMUNITY CENTER, INC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 148 HAMILTON AVE 2ND FLOOR
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City | WHITE PLAINS
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State | NY
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Zip | 10601-1702
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Country | US
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Telephone | 914-949-3112
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Fax | 914-949-5952
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Provider Business Mailing Address
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Address Line | 52 N BROADWAY
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City | WHITE PLAINS
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State | NY
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Zip | 10603-3710
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Country | US
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Telephone | 914-949-3098
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Fax | 914-761-2105
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Authorized Official
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Title or Position | CEO
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Name | MR. PAUL ANDERSON-WINCHELL
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Credential |
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Telephone | 914-949-3098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 6012L001
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License Number State | NY
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