MEDICARE: GUIDING GRACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	810644	OTHER	KY	AODE LICENSURE
3	800289	OTHER	KY	BHSO LICENSURE

General Provider Information

NPI Number	:	1235625104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING GRACE

Provider Business Mailing Address
First Line	:	131 ALLYSON CIR
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440-9041
Country	:	US
Telephone Number	:	859-325-5545
Fax Number	:	859-605-2038

Provider Business Practice Location Address
First Line	:	51 E SHELBY STREET
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440
Country	:	US
Telephone Number	:	859-325-5545
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MARY E KOPPEL
Credential	:
Telephone Number	:	859-325-5545

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	03/05/2020

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Directions to “GUIDING GRACE ” Practice Location

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