Provider Demographics
NPI:1164615209
Name:GRAMMY'S HOUSE ARTESIA DOMESTIC VIOLENCE SHELTER
Entity Type:Organization
Organization Name:GRAMMY'S HOUSE ARTESIA DOMESTIC VIOLENCE SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-748-1198
Mailing Address - Street 1:811 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1968
Mailing Address - Country:US
Mailing Address - Phone:505-748-1198
Mailing Address - Fax:505-748-7334
Practice Address - Street 1:811 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1968
Practice Address - Country:US
Practice Address - Phone:505-748-1198
Practice Address - Fax:505-748-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1654490251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable