Provider Demographics
NPI:1225671035
Name:GRACEFUL CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:GRACEFUL CARE MANAGEMENT LLC
Other - Org Name:GRACEFUL CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOWN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:903-586-3505
Mailing Address - Street 1:PO BOX 1766
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-1766
Mailing Address - Country:US
Mailing Address - Phone:903-586-3505
Mailing Address - Fax:
Practice Address - Street 1:203 NACOGDOCHES ST STE 360
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2454
Practice Address - Country:US
Practice Address - Phone:903-586-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care