Provider Demographics
NPI:1275253080
Name:GRACE CARE PROVIDER
Entity Type:Organization
Organization Name:GRACE CARE PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:210-379-4100
Mailing Address - Street 1:PO BOX 691181
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-1181
Mailing Address - Country:US
Mailing Address - Phone:210-379-4100
Mailing Address - Fax:210-696-0992
Practice Address - Street 1:12422 WANDERING TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2109
Practice Address - Country:US
Practice Address - Phone:210-379-4100
Practice Address - Fax:210-696-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care