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General NPI Number Information
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NPI Number | 1659109106
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Entity Type | Organization
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Legal Business Name | EUPHORIA GRACE HOMES LLC
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 424 BEECH CT
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City | FORNEY
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State | TX
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Zip | 75126-6925
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Country | US
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Telephone | 859-230-7553
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Fax |
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Provider Business Mailing Address
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Address Line | 123 FLAMINGO ROAD
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 859-230-7553
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHIDINMA CYNTHIA UKAH
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Credential | NP
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Telephone | 859-230-7553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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 | 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 #4
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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