Healthcare Provider Details

I. General information

NPI: 1477715704
Provider Name (Legal Business Name): LIVING GRACE ASSISTED LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14822 CHARLMONT DR
HOUSTON TX
77083-5648
US

IV. Provider business mailing address

14822 CHARLMONT DR
HOUSTON TX
77083-5648
US

V. Phone/Fax

Practice location:
  • Phone: 832-877-6566
  • Fax: 866-249-2956
Mailing address:
  • Phone: 832-877-6566
  • Fax: 866-249-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN A SOWUNMI
Title or Position: DIRECTOR
Credential:
Phone: 832-877-6566