Provider Demographics
NPI:1922581958
Name:VISIBLE GRACE HEALTHCARE LLC
Entity Type:Organization
Organization Name:VISIBLE GRACE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEBANJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ISEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-887-6575
Mailing Address - Street 1:9805 HARWIN DR STE D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9805 HARWIN DR STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1615
Practice Address - Country:US
Practice Address - Phone:832-887-6575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)