1235300682 NPI number — NEW GRACE HOME HEALTH SERVICES INC

Table of content: (NPI 1235300682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235300682 NPI number — NEW GRACE HOME HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW GRACE 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:
1235300682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2622 WOODPARK DR
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:
75044-7882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-431-6712
Provider Business Mailing Address Fax Number:
972-997-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2622 WOODPARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75044-7882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-431-6712
Provider Business Practice Location Address Fax Number:
469-298-3233
Provider Enumeration Date:
03/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
UDEOGU-MOORE
Authorized Official First Name:
WINIFRED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
214-431-6712

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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 © 2007-2025 www.npivalidator.com