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NPI Code Detail

MEDICARE: GRACE PLACE COLLIN LLC

MEDICARE: GRACE PLACE COLLIN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2261QR0800XRecovery Care Clinic/Center

General Provider Information

NPI Number : 1306336870
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE PLACE COLLIN LLC
Provider Business Mailing Address
First Line : 6115 CUPERTINO TRL
Second Line :
City : DALLAS
State : TX
Zip : 75252-2642
Country : US
Telephone Number : 414-839-4755
Fax Number : 888-320-7479
Provider Business Practice Location Address
First Line : 6115 CUPERTINO TRL
Second Line :
City : DALLAS
State : TX
Zip : 75252-2642
Country : US
Telephone Number : 414-839-4755
Fax Number : 888-320-7479
Authorized Official
Title or Position : CEO
Name : SHANESE MCCLENDON
Credential :
Telephone Number : 414-839-4755
Provider Enumeration Date : 05/10/2018
Last Update Date : 11/14/2024

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Directions to “GRACE PLACE COLLIN LLC ” Practice Location

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