Provider Demographics
NPI:1518524602
Name:GRACE OUTREACH MINISTRIES INTERNATIONAL, INC
Entity Type:Organization
Organization Name:GRACE OUTREACH MINISTRIES INTERNATIONAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LETISHA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-593-8042
Mailing Address - Street 1:4438 WALKING STICK WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-7487
Mailing Address - Country:US
Mailing Address - Phone:706-593-8042
Mailing Address - Fax:
Practice Address - Street 1:3360 BUENA VISTA RD STE 12
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4286
Practice Address - Country:US
Practice Address - Phone:706-760-4631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution