MEDICARE: GRACEFUL HEARTS HOME 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1952263691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL HEARTS HOME LLC

Provider Business Mailing Address
First Line	:	2909 SANTA ANNA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-1759
Country	:	US
Telephone Number	:	214-334-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 SANTA ANNA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-1759
Country	:	US
Telephone Number	:	214-334-8979
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY LAWRENCE
Credential	:
Telephone Number	:	214-334-8979

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “GRACEFUL HEARTS HOME LLC ” Practice Location

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