Provider Demographics
NPI:1528770831
Name:RUGGED GRACE, LLC
Entity type:Organization
Organization Name:RUGGED GRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MENSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-698-3599
Mailing Address - Street 1:1547 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1066
Mailing Address - Country:US
Mailing Address - Phone:317-406-8191
Mailing Address - Fax:
Practice Address - Street 1:704 N STATE ST STE A
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3616
Practice Address - Country:US
Practice Address - Phone:317-406-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty