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General NPI Number Information
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NPI Number | 1013215045
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Entity Type | Organization
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Legal Business Name | DIVINE GRACE MEDICAL MISSIONARIES, INC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 8449 W BELLFORT ST # 200
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City | HOUSTON
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State | TX
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Zip | 77071-2245
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Country | US
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Telephone | 713-773-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 8449 W BELLFORT ST # 200
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City | HOUSTON
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State | TX
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Zip | 77071-2245
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Country | US
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Telephone | 713-773-1232
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | EDITH AGUH
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Credential | BSC
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Telephone | 713-773-1232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | TX
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