Provider Demographics
NPI:1861486755
Name:GRACE CARE OF TEXAS, INC.
Entity Type:Organization
Organization Name:GRACE CARE OF TEXAS, INC.
Other - Org Name:COMMUNITY CARE CENTER OF BAYLOR COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-442-6020
Mailing Address - Street 1:1110 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-3965
Mailing Address - Country:US
Mailing Address - Phone:940-889-3176
Mailing Address - Fax:940-889-8806
Practice Address - Street 1:1110 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-3965
Practice Address - Country:US
Practice Address - Phone:940-889-3176
Practice Address - Fax:940-889-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112844314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004421Medicaid
675042Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER