Provider Demographics
NPI:1558188607
Name:GRACEWORKS LUTHERAN SERVICES
Entity type:Organization
Organization Name:GRACEWORKS LUTHERAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-262-7212
Mailing Address - Street 1:6445 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2725
Mailing Address - Country:US
Mailing Address - Phone:937-433-2110
Mailing Address - Fax:
Practice Address - Street 1:6445 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2725
Practice Address - Country:US
Practice Address - Phone:937-433-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACEWORKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility