Provider Demographics
NPI:1477715704
Name:LIVING GRACE ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:LIVING GRACE ASSISTED LIVING, INC
Other - Org Name:ULTIMATE PERSONAL CARE HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOWUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-877-6566
Mailing Address - Street 1:14822 CHARLMONT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5648
Mailing Address - Country:US
Mailing Address - Phone:832-877-6566
Mailing Address - Fax:866-249-2956
Practice Address - Street 1:14822 CHARLMONT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5648
Practice Address - Country:US
Practice Address - Phone:832-877-6566
Practice Address - Fax:866-249-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251B00000XAgenciesCase Management
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care