Provider Demographics
NPI:1417297383
Name:GRACIA HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:GRACIA HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:FON
Authorized Official - Last Name:TOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-925-0120
Mailing Address - Street 1:9450 FOREST SPRINGS DRIVE
Mailing Address - Street 2:APT 2503
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:972-925-0120
Mailing Address - Fax:800-901-4794
Practice Address - Street 1:9550 FOREST LANE SUITE 214
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:972-925-0120
Practice Address - Fax:800-901-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX015694251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health