Organization
PEACE OF GRACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA PORTER (CEO)
(480) 561-8554
Entity
Organization
Contact information
Practice address
9815 W RIVERSIDE AVE, TOLLESON, AZ 85353-8585
(602) 780-0252
(833) 667-0203
Mailing address
9815 W RIVERSIDE AVE, TOLLESON, AZ 85353-8585
(602) 780-0252
(833) 667-0203
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
282J00000X
Religious Nonmedical Health Care Institution
—
—
Other
Enumeration date
09/16/2020
Last updated
09/16/2020
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