Provider Demographics
NPI:1275641458
Name:GRACE CARE OF TEXAS
Entity Type:Organization
Organization Name:GRACE CARE OF TEXAS
Other - Org Name:COMMUNITY CARE CENTER OF CROCKETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEIVERSHIP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:CROWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-278-3566
Mailing Address - Street 1:505 W CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5445
Mailing Address - Country:US
Mailing Address - Phone:972-278-3566
Mailing Address - Fax:972-840-0888
Practice Address - Street 1:1150 E LOOP 304
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1810
Practice Address - Country:US
Practice Address - Phone:936-544-2051
Practice Address - Fax:936-544-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455577Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER