Provider Demographics
NPI:1871514935
Name:GRACES TLC HOME INC
Entity type:Organization
Organization Name:GRACES TLC HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-270-1221
Mailing Address - Street 1:8700 COMMERCE PARK
Mailing Address - Street 2:STE #204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-270-1221
Mailing Address - Fax:713-270-0006
Practice Address - Street 1:8700 COMMERCE PARK
Practice Address - Street 2:STE #204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-270-1221
Practice Address - Fax:713-270-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009268251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176047201Medicaid