Provider Demographics
NPI:1093928533
Name:GRACE RESIDENTIAL ENTERPRISES
Entity Type:Organization
Organization Name:GRACE RESIDENTIAL ENTERPRISES
Other - Org Name:LEA FARMS RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPA
Authorized Official - Phone:325-673-3397
Mailing Address - Street 1:1318 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5552
Mailing Address - Country:US
Mailing Address - Phone:325-673-3397
Mailing Address - Fax:325-673-3397
Practice Address - Street 1:1318 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5552
Practice Address - Country:US
Practice Address - Phone:325-673-3397
Practice Address - Fax:325-673-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116790315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities