Provider Demographics
| NPI: | 1154071819 |
|---|---|
| Name: | TRIED BY GRACE MINISTRIES |
| Entity type: | Organization |
| Organization Name: | TRIED BY GRACE MINISTRIES |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VICE PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | GRACIA |
| Authorized Official - Middle Name: | WALU |
| Authorized Official - Last Name: | SHEMBO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MHA |
| Authorized Official - Phone: | 774-316-9331 |
| Mailing Address - Street 1: | 9805 STATESVILLE RD STE 6430 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CHARLOTTE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28269-7647 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 774-316-9331 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 10502 ATKINS RIDGE DR |
| Practice Address - Street 2: | |
| Practice Address - City: | CHARLOTTE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28213-4296 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 940-494-2516 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-03-25 |
| Last Update Date: | 2022-03-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | |
| No | 177F00000X | Other Service Providers | Lodging | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251K00000X | Agencies | Public Health or Welfare | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251V00000X | Agencies | Voluntary or Charitable | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
| No | 261QR0800X | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
| No | 343800000X | Transportation Services | Secured Medical Transport (VAN) |
