Provider Demographics
NPI:1235300682
Name:NEW GRACE HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:NEW GRACE HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:UDEOGU-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-431-6712
Mailing Address - Street 1:2622 WOODPARK DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7882
Mailing Address - Country:US
Mailing Address - Phone:214-431-6712
Mailing Address - Fax:972-997-9099
Practice Address - Street 1:2622 WOODPARK DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7882
Practice Address - Country:US
Practice Address - Phone:214-431-6712
Practice Address - Fax:469-298-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747359Medicare PIN