Provider Demographics
NPI:1609491182
Name:GRACE ABBEY COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:GRACE ABBEY COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-316-4129
Mailing Address - Street 1:405 E STATE HIGHWAY 121
Mailing Address - Street 2:BUILDING A, SUITE A250
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-4787
Mailing Address - Country:US
Mailing Address - Phone:337-316-4129
Mailing Address - Fax:
Practice Address - Street 1:405 E STATE HIGHWAY 121 STE A
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-4787
Practice Address - Country:US
Practice Address - Phone:337-316-4129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE ABBEY COMMUNITY DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management