1609908409 NPI number — GRACE VISITING NURSES AND HOME HEALTH SERVICES, INC.

Table of content: (NPI 1609908409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609908409 NPI number — GRACE VISITING NURSES AND HOME HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE VISITING NURSES AND HOME HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609908409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CASH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75766-8869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-586-9485
Provider Business Mailing Address Fax Number:
903-589-1186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75766-8869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-586-9485
Provider Business Practice Location Address Fax Number:
903-589-1186
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEITH
Authorized Official First Name:
AUBREY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
903-586-9485

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  003045 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001012548 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001012549 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001002194 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168313801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com