Provider Demographics
NPI:1457727182
Name:CHRISTY GRACE HEALTH CENTER INC
Entity Type:Organization
Organization Name:CHRISTY GRACE HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OYEN
Authorized Official - Middle Name:JOSHUA BORNGT
Authorized Official - Last Name:IYAMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-586-9963
Mailing Address - Street 1:2000 S IH 35 STE Q8C
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6917
Mailing Address - Country:US
Mailing Address - Phone:512-586-9963
Mailing Address - Fax:512-271-8358
Practice Address - Street 1:2000 S IH 35 STE Q8C
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6917
Practice Address - Country:US
Practice Address - Phone:512-586-9963
Practice Address - Fax:512-271-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363595501Medicaid