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General NPI Number Information
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NPI Number | 1245020098
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Entity Type | Organization
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Legal Business Name | GRACE COVENANT HOME HEALTH CARE OF TEXAS LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3746 OAK MEADOW DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-6506
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Country | US
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Telephone | 817-374-7012
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 542411
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-2411
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Country | US
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Telephone | 817-374-7012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OMONOH EHI
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Credential |
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Telephone | 817-374-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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