# GRACE PLACE FOR WOMEN, INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104107192
- **Authorized official:** DEBORAH JOSLIN (CEO)
- **Authorized official phone:** (505) 327-4747

## Contact information

- **Practice address:** 4801 N BUTLER AVE STE 3102, FARMINGTON, NM 87401-0815
- **Practice address phone:** (505) 327-4747
- **Practice address fax:** (505) 327-2025
- **Mailing address:** PO BOX 2256, FARMINGTON, NM 87499-2256
- **Mailing address phone:** (505) 327-4747
- **Mailing address fax:** (505) 327-2025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | MD2010-0229 | NM | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | MD2010-0578 | NM | — |
| 363A00000X | Physician Assistant | PA2008-0053 | NM | — |

## Other

- **Enumeration date:** 09/02/2011
- **Last updated:** 05/23/2012