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General NPI Number Information
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NPI Number | 1174387971
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Entity Type | Organization
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Legal Business Name | BACKED BY GRACE PLLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 2451 KLAMATH DR
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City | LEWISVILLE
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State | TX
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Zip | 75056-6789
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Country | US
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Telephone | 214-597-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 2451 KLAMATH DR
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City | LEWISVILLE
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State | TX
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Zip | 75056-6789
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Country | US
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Telephone | 214-597-4465
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Fax |
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Authorized Official
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Title or Position | MISS/NURSE PRACITIONER
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Name | MARVISE IJEOMA ODUAGU
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Credential | NP
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Telephone | 214-597-4465
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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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