Provider Demographics
NPI:1598929374
Name:GRACE COMMUNITY MENTAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:GRACE COMMUNITY MENTAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-277-0675
Mailing Address - Street 1:7924 W BROADWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581
Mailing Address - Country:US
Mailing Address - Phone:281-412-6435
Mailing Address - Fax:281-412-5060
Practice Address - Street 1:7924 BROADWAY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7932
Practice Address - Country:US
Practice Address - Phone:281-412-6435
Practice Address - Fax:281-412-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)