Healthcare Provider Details

I. General information

NPI: 1326489667
Provider Name (Legal Business Name): AGING GRACE HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17507 BIG BASIN LN
HUMBLE TX
77346-1560
US

IV. Provider business mailing address

17507 BIG BASIN LN
HUMBLE TX
77346-1560
US

V. Phone/Fax

Practice location:
  • Phone: 713-775-2888
  • Fax:
Mailing address:
  • Phone: 713-775-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SHUNDA THOMPSON
Title or Position: OWNER
Credential: DDS
Phone: 713-775-2888