Provider Demographics
NPI:1609908409
Name:GRACE VISITING NURSES AND HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GRACE VISITING NURSES AND HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-586-9485
Mailing Address - Street 1:111 CASH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-8869
Mailing Address - Country:US
Mailing Address - Phone:903-586-9485
Mailing Address - Fax:903-589-1186
Practice Address - Street 1:111 CASH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-8869
Practice Address - Country:US
Practice Address - Phone:903-586-9485
Practice Address - Fax:903-589-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003045251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012548Medicaid
TX001012549Medicaid
TX001002194Medicaid
TX168313801Medicaid
TX001012549Medicaid