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General NPI Number Information
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NPI Number | 1316374119
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Entity Type | Organization
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Legal Business Name | EXTENDED GRACE HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 1605 BRANCHVIEW CT
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City | KELLER
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State | TX
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Zip | 76248-6833
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Country | US
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Telephone | 817-576-2408
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Fax | 817-916-8802
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Provider Business Mailing Address
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Address Line | 8528 DAVIS BLVD # 134-208
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76182-8367
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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 | DIRECTOR OF CLIENT SERVICES
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Name | PREETHI ABRAHAM
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Credential |
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Telephone | 817-576-2408
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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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