MEDICARE: GRACE HOMESTEAD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	310400000X	Assisted Living Facility	102479	TX
3	251E00000X	Home Health Agency
4	253Z00000X	In Home Supportive Care Agency
5	282E00000X	Long Term Care Hospital
6	343800000X	Secured Medical Transport (VAN)
7	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
8	261QM0850X	Adult Mental Health Clinic/Center
9	347C00000X	Private Vehicle
10	347E00000X	Transportation Broker
11	342000000X	Transportation Network Company
12	385H00000X	Respite Care
13	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1215459193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOMESTEAD LLC

Provider Business Mailing Address
First Line	:	6604 HERBERT RD
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-7239
Country	:	US
Telephone Number	:	469-235-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6604 HERBERT RD
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-7239
Country	:	US
Telephone Number	:	469-235-7900
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. GAIL GUDZA
Credential	:
Telephone Number	:	469-235-7900

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	03/09/2026

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Directions to “GRACE HOMESTEAD LLC ” Practice Location

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