Provider Demographics
NPI:1891234134
Name:GRACELAND PERSONAL CARE HOMES, INC
Entity Type:Organization
Organization Name:GRACELAND PERSONAL CARE HOMES, INC
Other - Org Name:CARRIES ASSISTED LIVING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:903-692-1976
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:2625 CR 302
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-0329
Mailing Address - Country:US
Mailing Address - Phone:903-694-9290
Mailing Address - Fax:903-693-9617
Practice Address - Street 1:2625 COUNTY ROAD 302
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-4103
Practice Address - Country:US
Practice Address - Phone:903-694-9290
Practice Address - Fax:903-693-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility