Provider Demographics
NPI:1124864186
Name:GRACE COMMUNITY CHURCH OF RENO
Entity type:Organization
Organization Name:GRACE COMMUNITY CHURCH OF RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-525-8020
Mailing Address - Street 1:6180 MAE ANNE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4708
Mailing Address - Country:US
Mailing Address - Phone:775-525-8010
Mailing Address - Fax:
Practice Address - Street 1:6180 MAE ANNE AVE STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-4708
Practice Address - Country:US
Practice Address - Phone:775-525-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE COMMUNITY CHURCH OF RENO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty