Organization
GUIDING GRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AVERY D WILES MANAGING MEMBER (CEO)
(469) 444-3714
Entity
Organization
Contact information
Practice address
405 STATE HIGHWAY 121, STE A250, LEWISVILLE, TX 75067
(469) 444-3714
Mailing address
405 STATE HIGHWAY 121, STE A250, LEWISVILLE, TX 75067
(469) 444-3714
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609491182
—
TX
Enumeration date
06/15/2020
Last updated
06/15/2020
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