Provider Demographics
NPI:1801027701
Name:GRACE EV. LUTHERAN CHURCH
Entity Type:Organization
Organization Name:GRACE EV. LUTHERAN CHURCH
Other - Org Name:GRACE EXTENSION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONGREGATION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-623-6633
Mailing Address - Street 1:830 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4812
Mailing Address - Country:US
Mailing Address - Phone:520-623-6633
Mailing Address - Fax:
Practice Address - Street 1:830 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4812
Practice Address - Country:US
Practice Address - Phone:520-623-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE EV. LUTHERAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable