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General NPI Number Information
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NPI Number | 1053606301
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Entity Type | Organization
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Legal Business Name | LOVING GRACE HEALTH CARE, INC
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 17504 WISEMAN DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-5720
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Country | US
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Telephone | 512-673-9362
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Fax |
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Provider Business Mailing Address
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Address Line | 17504 WISEMAN DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-5720
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Country | US
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Telephone | 512-673-9362
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLASIMBO OBAWOLE
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Credential |
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Telephone | 512-673-9362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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