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General NPI Number Information
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NPI Number | 1326290321
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Entity Type | Organization
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Legal Business Name | GRACE WELLNESS & REHABILITATION, LLC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 3119 BERKSHIRE LN
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City | CORINTH
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State | TX
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Zip | 76210-1726
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Country | US
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Telephone | 214-629-6635
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1804
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City | LAKE DALLAS
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State | TX
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Zip | 75065-1804
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Country | US
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Telephone | 214-629-6635
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GRACE EUBANKS
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Credential | OT
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Telephone | 214-629-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 554930000
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License Number State | TX
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