MEDICARE: POINT OF GRACE HOME HEALTH

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
1	163W00000X	Registered Nurse	844153	TX
2	251B00000X	Case Management Agency	844153	TX
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251F00000X	Home Infusion Agency
5	251F00000X	Home Infusion Agency	844153	TX
6	347C00000X	Private Vehicle
7	385HR2065X	Child Physical Disabilities Respite Care
8	251E00000X	Home Health Agency	844153	TX

General Provider Information

NPI Number	:	1457801391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POINT OF GRACE HOME HEALTH

Provider Business Mailing Address
First Line	:	606 ORIOLE BLVD
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-3500
Country	:	US
Telephone Number	:	817-443-8775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 MILL SPRING PASS
Second Line	:
City	:	FORT
State	:	TX
Zip	:	76123
Country	:	US
Telephone Number	:	817-443-8775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELE GRAHAM
Credential	:	RN, BSN
Telephone Number	:	817-443-8775

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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Directions to “POINT OF GRACE HOME HEALTH ” Practice Location

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