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General NPI Number Information
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NPI Number | 1659818235
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Entity Type | Organization
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Legal Business Name | EZ GRACE RESIDENTIAL HOME CARE
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 919 SADDLEBROOK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78245-1630
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Country | US
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Telephone | 210-994-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 919 SADDLEBROOK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78245-1630
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Country | US
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Telephone | 210-994-8210
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Fax |
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | VICTORIA DELANO
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Credential | RN
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Telephone | 240-478-0095
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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 | 106661
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | 106661
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License Number State | TX
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