MEDICARE: A PLACE OF GRACE

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1982974895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLACE OF GRACE

Provider Business Mailing Address
First Line	:	8614 E RACHLIN CIR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2816
Country	:	US
Telephone Number	:	713-772-6545
Fax Number	:

Provider Business Practice Location Address
First Line	:	8614 E RACHLIN CIR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2816
Country	:	US
Telephone Number	:	713-772-6545
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LESTER L SHEPHERD
Credential	:
Telephone Number	:	713-772-6546

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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Directions to “A PLACE OF GRACE ” Practice Location

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