Provider Demographics
NPI:1619705134
Name:GRACE COMMUNITY HEALTHCARE MINISTRY
Entity type:Organization
Organization Name:GRACE COMMUNITY HEALTHCARE MINISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-363-6361
Mailing Address - Street 1:312 N PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1712
Mailing Address - Country:US
Mailing Address - Phone:903-569-0020
Mailing Address - Fax:903-569-0029
Practice Address - Street 1:312 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1712
Practice Address - Country:US
Practice Address - Phone:903-363-6361
Practice Address - Fax:903-569-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center