Provider Demographics
NPI:1538508635
Name:GRACE EMERGENCY ROOM, LLC
Entity Type:Organization
Organization Name:GRACE EMERGENCY ROOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AYO
Authorized Official - Middle Name:AYODEJI
Authorized Official - Last Name:AJIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-773-2758
Mailing Address - Street 1:3319 WILD RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406
Mailing Address - Country:US
Mailing Address - Phone:281-773-2758
Mailing Address - Fax:
Practice Address - Street 1:10900 GULF FWY
Practice Address - Street 2:#B102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-2580
Practice Address - Country:US
Practice Address - Phone:713-947-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty