Provider Demographics
NPI:1326794470
Name:GRACELAND HEALTH SERVICES INC
Entity Type:Organization
Organization Name:GRACELAND HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRPGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGODEYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-316-6150
Mailing Address - Street 1:17934 ROYAL GATE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4764
Mailing Address - Country:US
Mailing Address - Phone:346-316-6150
Mailing Address - Fax:
Practice Address - Street 1:17934 ROYAL GATE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4764
Practice Address - Country:US
Practice Address - Phone:346-316-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services