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General NPI Number Information
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NPI Number | 1982974895
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Entity Type | Organization
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Legal Business Name | A PLACE OF GRACE
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 8614 E RACHLIN CIR
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City | HOUSTON
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State | TX
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Zip | 77071-2816
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Country | US
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Telephone | 713-772-6545
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Fax |
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Provider Business Mailing Address
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Address Line | 8614 E RACHLIN CIR
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City | HOUSTON
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State | TX
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Zip | 77071-2816
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Country | US
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Telephone | 713-772-6545
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESTER L SHEPHERD
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Credential |
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Telephone | 713-772-6546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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