Healthcare Provider Details

I. General information

NPI: 1659109106
Provider Name (Legal Business Name): EUPHORIA GRACE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 BEECH CT
FORNEY TX
75126-6925
US

IV. Provider business mailing address

123 FLAMINGO ROAD
FORNEY TX
75126
US

V. Phone/Fax

Practice location:
  • Phone: 859-230-7553
  • Fax:
Mailing address:
  • Phone: 859-230-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHIDINMA CYNTHIA UKAH
Title or Position: DIRECTOR
Credential: NP
Phone: 859-230-7553