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General NPI Number Information
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NPI Number | 1518524602
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Entity Type | Organization
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Legal Business Name | GRACE OUTREACH MINISTRIES INTERNATIONAL, INC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 3360 BUENA VISTA RD STE 12
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City | COLUMBUS
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State | GA
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Zip | 31906-4286
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Country | US
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Telephone | 706-760-4631
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Fax |
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Provider Business Mailing Address
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Address Line | 4438 WALKING STICK WAY
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City | COLUMBUS
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State | GA
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Zip | 31907-7487
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Country | US
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Telephone | 706-593-8042
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. LETISHA YVONNE RICE
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Credential | LPN
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Telephone | 706-593-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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