Provider Demographics
NPI:1104858539
Name:UNLIMITED GRACE HEALTHCARE LLC
Entity Type:Organization
Organization Name:UNLIMITED GRACE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-8800
Mailing Address - Street 1:2401 GATEWAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2743
Mailing Address - Country:US
Mailing Address - Phone:214-277-8800
Mailing Address - Fax:214-277-8899
Practice Address - Street 1:2401 GATEWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:214-277-8800
Practice Address - Fax:214-277-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009284251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009284OtherDADS LICENSE NUMBER
TX1785529Medicaid
TX457956Medicare Oscar/Certification