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General NPI Number Information
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NPI Number | 1699985432
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Entity Type | Organization
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Legal Business Name | GRACELAND PERSONAL CARE HOMES, INC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1315 SPRING ST 2625 CR 302
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City | CARTHAGE
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State | TX
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Zip | 75633-2061
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Country | US
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Telephone | 903-693-9617
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Fax | 903-694-9191
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Provider Business Mailing Address
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Address Line | PO BOX 329 2625 CR 302
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City | CARTHAGE
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State | TX
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Zip | 75633-0329
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Country | US
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Telephone | 903-693-9617
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Fax | 903-694-9191
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOBBY R WILLIAMS
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Credential |
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Telephone | 903-692-1976
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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 | 030117
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License Number State | TX
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