| Rugged Grace, Llc | |
|
704 N State St Ste A Greenfield IN 46140-3616 | |
| (317) 406-8191 | |
| Not Available |
| Full Name | Rugged Grace, Llc |
|---|---|
| Speciality | Counselor |
| Location | 704 N State St Ste A, Greenfield, Indiana |
| Authorized Official Name and Position | Jennifer Renee Menser (MANAGING MEMBER) |
| Authorized Official Contact | 3176983599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rugged Grace, Llc 1547 N State St Greenfield IN 46140-1066 Ph: (317) 406-8191 | Rugged Grace, Llc 704 N State St Ste A Greenfield IN 46140-3616 Ph: (317) 406-8191 |
| NPI Number | 1528770831 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 12/19/2022 |
| Certification Date | 12/19/2022 |
| Medicare PECOS PAC ID | 6709246853 |
|---|---|
| Medicare Enrollment ID | O20230720002104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528770831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer R Menser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437813789 PECOS PAC ID: 8224421144 Enrollment ID: I20220216002404 |
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