Healthcare Provider Details

I. General information

NPI: 1013321579
Provider Name (Legal Business Name): GRACY WOODS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12042 BITTERN HOLW
AUSTIN TX
78758-3350
US

IV. Provider business mailing address

410 MONMOUTH AVE SUITE 130
LAKEWOOD NJ
08701-3711
US

V. Phone/Fax

Practice location:
  • Phone: 512-730-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MENDY SHAPIRO
Title or Position: MANAGER
Credential:
Phone: 732-961-9000