Provider Demographics
NPI:1548376072
Name:GRACE HOUSE MINISTRIES, INC.
Entity type:Organization
Organization Name:GRACE HOUSE MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-786-4663
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:4923 FARRELL AVE
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-0547
Mailing Address - Country:US
Mailing Address - Phone:205-786-4663
Mailing Address - Fax:205-780-0750
Practice Address - Street 1:4923 FARRELL AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-2337
Practice Address - Country:US
Practice Address - Phone:205-786-4663
Practice Address - Fax:205-780-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL019448322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children