Provider Demographics
NPI:1477209054
Name:GRACE HEALTHCARE STAFFING AGENCY
Entity Type:Organization
Organization Name:GRACE HEALTHCARE STAFFING AGENCY
Other - Org Name:GRACE HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTRAMESE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-455-2762
Mailing Address - Street 1:4670 CORLEY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4670 CORLEY ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4221
Practice Address - Country:US
Practice Address - Phone:409-455-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory