MEDICARE: GRACEFUL HARVEST

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	313M00000X	Nursing Facility/Intermediate Care Facility
3	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1841083698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL HARVEST

Provider Business Mailing Address
First Line	:	1300 S POLK ST STE 295
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 RICHARD PITTMON DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-1226
Country	:	US
Telephone Number	:	469-493-7066
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MRS. ARIAN DIGGS
Credential	:
Telephone Number	:	469-493-7066

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	05/26/2025

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Directions to “GRACEFUL HARVEST ” Practice Location

Language	Start Address	Practice Location

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