MEDICARE: POINT OF GRACE HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251F00000X	Home Infusion Agency
4	251J00000X	Nursing Care Agency
5	251S00000X	Community/Behavioral Health Agency
6	343900000X	Non-emergency Medical Transport (VAN)
7	385H00000X	Respite Care
8	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
9	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1740731017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POINT OF GRACE HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	2533 MILL SPRING PASS
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123
Country	:	US
Telephone Number	:	817-443-8775
Fax Number	:	817-886-7303

Provider Business Practice Location Address
First Line	:	2533 MILL SPRINGS PASS
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2615
Country	:	US
Telephone Number	:	817-443-8775
Fax Number	:	817-886-7303

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

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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