Provider Demographics
NPI:1972733640
Name:GRAPEVINE CENTER
Entity type:Organization
Organization Name:GRAPEVINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-283-1704
Mailing Address - Street 1:140 NORTH ELM ST. SUITE B
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4820
Mailing Address - Country:US
Mailing Address - Phone:724-283-1704
Mailing Address - Fax:724-283-8635
Practice Address - Street 1:140 NORTH ELM ST. SUITE B
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4820
Practice Address - Country:US
Practice Address - Phone:724-283-1704
Practice Address - Fax:724-283-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center