Provider Demographics
NPI:1609158880
Name:HEALING GRACE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:HEALING GRACE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-293-2420
Mailing Address - Street 1:9 SPRING GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-3419
Mailing Address - Country:US
Mailing Address - Phone:817-293-2420
Mailing Address - Fax:817-293-2720
Practice Address - Street 1:9 SPRING GARDEN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-3419
Practice Address - Country:US
Practice Address - Phone:817-293-2420
Practice Address - Fax:817-293-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015038251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health