Provider Demographics
NPI:1790054153
Name:GRACON INC
Entity Type:Organization
Organization Name:GRACON INC
Other - Org Name:HOME BOUND HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-2446
Mailing Address - Street 1:358 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3039
Mailing Address - Country:US
Mailing Address - Phone:870-425-2446
Mailing Address - Fax:870-424-2223
Practice Address - Street 1:358 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3039
Practice Address - Country:US
Practice Address - Phone:870-425-2446
Practice Address - Fax:870-424-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4607251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187776514Medicaid