1366452633 NPI number — GRACON, INC.

Table of content: (NPI 1366452633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366452633 NPI number — GRACON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACON, 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:
HOME BOUND MEDICAL
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:
1366452633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
358 HIGHWAY 5 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72653-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-425-2446
Provider Business Mailing Address Fax Number:
870-424-2223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
358 HIGHWAY 5 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72653-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-425-2446
Provider Business Practice Location Address Fax Number:
870-424-2223
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
GAYLA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
870-425-2446

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: AR4607 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 140830738 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142105732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223547797 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 234439765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164214797 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221146757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221880732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224179732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187776514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148927557 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150022765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224181757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 218335738 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219234797 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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