Provider Demographics
NPI:1528415007
Name:GRACESPRINGS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:GRACESPRINGS HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KUNBI
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-585-1108
Mailing Address - Street 1:4606 FM 1960 RD W, STE 322
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069
Mailing Address - Country:US
Mailing Address - Phone:832-585-1108
Mailing Address - Fax:832-585-1240
Practice Address - Street 1:4606 FM 1960 RD W, STE 322
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069
Practice Address - Country:US
Practice Address - Phone:832-585-1108
Practice Address - Fax:832-585-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 385H00000X
TX111111111251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384250201Medicaid