Healthcare Provider Details

I. General information

NPI: 1124622451
Provider Name (Legal Business Name): NE HEALTH OF GRAPEVINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 IRA E WOODS AVE
GRAPEVINE TX
76051-4213
US

IV. Provider business mailing address

784 US HIGHWAY 1 STE 200
NORTH PALM BEACH FL
33408-4415
US

V. Phone/Fax

Practice location:
  • Phone: 817-809-8000
  • Fax:
Mailing address:
  • Phone: 561-801-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SIOBAUGHN FRASER
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 561-801-4235