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General NPI Number Information
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NPI Number | 1053649319
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Entity Type | Organization
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Legal Business Name | GRACIOUS HOME HEALTH AGENCY AND MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 4731 N GALLOWAY AVE SUITE 103
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City | MESQUITE
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State | TX
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Zip | 75150-1512
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Country | US
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Telephone | 214-982-1598
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Fax |
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Provider Business Mailing Address
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Address Line | 4731 N GALLOWAY AVE SUITE 103
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City | MESQUITE
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State | TX
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Zip | 75150-1512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SAMUEL EMEKA AGHAZIEM
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Credential |
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Telephone | 214-982-1598
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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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