MEDICARE: GODS GRACE COMMUNITY CHURCH

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	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000262	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES

General Provider Information

NPI Number	:	1972757243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GODS GRACE COMMUNITY CHURCH

Provider Business Mailing Address
First Line	:	1106 W TIDWELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-5500
Country	:	US
Telephone Number	:	713-688-1985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 W TIDWELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-5500
Country	:	US
Telephone Number	:	713-688-1985
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PATRICIA BOYD
Credential	:
Telephone Number	:	713-688-1985

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	08/04/2009

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Directions to “GODS GRACE COMMUNITY CHURCH ” Practice Location

Language	Start Address	Practice Location

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