Healthcare Provider Details

I. General information

NPI: 1598573438
Provider Name (Legal Business Name): GRACE HEALTH & WELLNESS COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MAIN ST STE 404
RICHMOND TX
77469-3244
US

IV. Provider business mailing address

1601 MAIN ST STE 404
RICHMOND TX
77469-3244
US

V. Phone/Fax

Practice location:
  • Phone: 512-663-4661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL LANEY
Title or Position: OWNER
Credential: RN, AGCNS-BC
Phone: 512-663-4661