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General NPI Number Information
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NPI Number | 1588809669
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Entity Type | Organization
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Legal Business Name | GRACE ASSISTIVE PROGRAM SERVICES, LLC
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 1117 BEAVER BROOK LN
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City | DESOTO
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State | TX
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Zip | 75115-2752
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Country | US
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Telephone | 214-208-2790
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Fax | 972-499-8325
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Provider Business Mailing Address
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Address Line | PO BOX 2865
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City | DESOTO
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State | TX
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Zip | 75123-2865
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Country | US
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Telephone | 214-208-2790
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Fax | 972-499-8325
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. YOLANDA MICHELLE BROOKS
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Credential |
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Telephone | 214-208-2790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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