Provider Demographics
NPI:1902420086
Name:OPTASIA GRACE
Entity Type:Organization
Organization Name:OPTASIA GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEOPAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-229-1962
Mailing Address - Street 1:1908 TRANSCENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0900
Mailing Address - Country:US
Mailing Address - Phone:214-229-1962
Mailing Address - Fax:
Practice Address - Street 1:1908 TRANSCENDENCE DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-0900
Practice Address - Country:US
Practice Address - Phone:214-229-1962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care