Healthcare Provider Details

I. General information

NPI: 1700334430
Provider Name (Legal Business Name): GRACE EWELIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE EWELIKE LPN/LVN

II. Dates (important events)

Enumeration Date: 09/11/2016
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 ESTATE LN SUITE 240
DALLAS TX
75238-2315
US

IV. Provider business mailing address

9550 SKILLMAN ST STE 200
DALLAS TX
75243-8282
US

V. Phone/Fax

Practice location:
  • Phone: 972-310-6070
  • Fax: 214-484-9534
Mailing address:
  • Phone: 972-310-6070
  • Fax: 214-666-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number332643
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number332643
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: