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General NPI Number Information
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NPI Number | 1336021252
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Entity Type | Organization
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Legal Business Name | OLISA GRACE HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 12400 BROOKGLADE CIR UNIT 43
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City | HOUSTON
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State | TX
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Zip | 77099-1382
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Country | US
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Telephone | 410-746-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 12400 BROOKGLADE CIR UNIT 43
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City | HOUSTON
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State | TX
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Zip | 77099-1382
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Country | US
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Telephone | 410-746-9805
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IFEANYI EGBUNIKE
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Credential | PHD
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Telephone | 410-746-9805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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