Provider Demographics
NPI:1831659143
Name:HEAVENLY GRACE HOSPICE LLC
Entity Type:Organization
Organization Name:HEAVENLY GRACE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANJUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-205-5447
Mailing Address - Street 1:1210 VOLCANO AVE
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-8455
Mailing Address - Country:US
Mailing Address - Phone:956-205-5447
Mailing Address - Fax:
Practice Address - Street 1:1210 VOLCANO AVE
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8455
Practice Address - Country:US
Practice Address - Phone:956-205-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based