Provider Demographics
NPI:1639543655
Name:RESIDENT OF THE GRAYSTONE
Entity Type:Organization
Organization Name:RESIDENT OF THE GRAYSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAHYAHNEETAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-305-2290
Mailing Address - Street 1:PO BOX 171747
Mailing Address - Street 2:346
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003
Mailing Address - Country:US
Mailing Address - Phone:682-305-2290
Mailing Address - Fax:682-305-2284
Practice Address - Street 1:1727 OAK VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:682-305-2290
Practice Address - Fax:682-305-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253J00000XAgenciesFoster Care Agency