Provider Demographics
NPI:1366452633
Name:GRACON, INC.
Entity Type:Organization
Organization Name:GRACON, INC.
Other - Org Name:HOME BOUND MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-2446
Mailing Address - Street 1:358 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3039
Mailing Address - Country:US
Mailing Address - Phone:870-425-2446
Mailing Address - Fax:870-424-2223
Practice Address - Street 1:358 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3039
Practice Address - Country:US
Practice Address - Phone:870-425-2446
Practice Address - Fax:870-424-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X
ARAR4607251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140830738Medicaid
AR142105732Medicaid
AR223547797Medicaid
AR234439765Medicaid
AR164214797Medicaid
AR221146757Medicaid
AR221880732Medicaid
AR224179732Medicaid
AR187776514Medicaid
AR148927557Medicaid
AR150022765Medicaid
AR224181757Medicaid
AR218335738Medicaid
AR219234797Medicaid