1699985432 NPI number — GRACELAND PERSONAL CARE HOMES, INC

Table of content: (NPI 1699985432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699985432 NPI number — GRACELAND PERSONAL CARE HOMES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACELAND PERSONAL CARE HOMES, 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:
1699985432
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:
PO BOX 329
Provider Second Line Business Mailing Address:
2625 CR 302
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75633-0329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-693-9617
Provider Business Mailing Address Fax Number:
903-694-9191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 SPRING ST
Provider Second Line Business Practice Location Address:
2625 CR 302
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75633-2061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-693-9617
Provider Business Practice Location Address Fax Number:
903-694-9191
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-692-1976

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  030117 , 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)





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