1841819067 NPI number — GRACE ABOUND, LLC

Table of content: AMANDA MICHELLE MOONEY FNP (NPI 1215356001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841819067 NPI number — GRACE ABOUND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE ABOUND, LLC
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:
6
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:
1841819067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4014 CARAVEL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOURI CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77459-5041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-412-4011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4014 CARAVEL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-5041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-412-4011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-412-4011

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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