1184732364 NPI number — GRACE CARE OF TEXAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184732364 NPI number — GRACE CARE OF TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE CARE OF TEXAS
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:
GROVE GARDENS CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1184732364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 W CENTERVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75041-5445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 S GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75670-4069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-935-7886
Provider Business Practice Location Address Fax Number:
903-923-0058
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROWSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
O
Authorized Official Title or Position:
RECEIVERSHIP
Authorized Official Telephone Number:
972-278-3566

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  5088 , 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)





Copyright © 2007-2024 www.npivalidator.com