Provider Demographics
NPI:1508268236
Name:SHIELD OF GRACE HHC, LLC
Entity Type:Organization
Organization Name:SHIELD OF GRACE HHC, LLC
Other - Org Name:SHIELD OF GRACE HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:TERRAZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-592-4000
Mailing Address - Street 1:11395 JAMES WATT A-11
Mailing Address - Street 2:11395 JAMES WATT SUITE A-11
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-592-4000
Mailing Address - Fax:915-633-9855
Practice Address - Street 1:11395 JAMES WATT A-11
Practice Address - Street 2:11395 JAMES WATT SUITE A-11
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-592-4000
Practice Address - Fax:915-633-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty