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General NPI Number Information
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NPI Number | 1558188607
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Entity Type | Organization
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Legal Business Name | GRACEWORKS LUTHERAN SERVICES
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 6445 FAR HILLS AVE
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City | CENTERVILLE
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State | OH
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Zip | 45459-2725
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Country | US
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Telephone | 937-433-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 6445 FAR HILLS AVE
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City | CENTERVILLE
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State | OH
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Zip | 45459-2725
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Country | US
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Telephone | 937-433-2110
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LAUREN ELIZABETH COYLE
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Credential | LNHA
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Telephone | 937-262-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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