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General NPI Number Information
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NPI Number | 1407389794
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN MINISTRIES
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1709 JOHNSON RD
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City | SPRINGDALE
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State | AR
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Zip | 72762-6022
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Country | US
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Telephone | 501-420-4515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 956
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City | ROGERS
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State | AR
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Zip | 72757-0956
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Country | US
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Telephone | 501-420-4515
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FAMILY SERVICES
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Name | ANNIE MARTIN
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Credential |
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Telephone | 479-633-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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