Provider Demographics
NPI:1154500429
Name:GRACE CENTER ADULT DAY CARE & RECREATION
Entity Type:Organization
Organization Name:GRACE CENTER ADULT DAY CARE & RECREATION
Other - Org Name:GRACE CENTER ADULT DAY CARE & RECREATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:VALLEJO
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-969-8786
Mailing Address - Street 1:502 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5942
Mailing Address - Country:US
Mailing Address - Phone:956-969-8786
Mailing Address - Fax:956-969-8954
Practice Address - Street 1:502 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5942
Practice Address - Country:US
Practice Address - Phone:956-969-8786
Practice Address - Fax:956-969-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119889261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013117Medicaid