Provider Demographics
NPI:1639593122
Name:GRACIOUS HEALTH AND HOSPICE,INC
Entity type:Organization
Organization Name:GRACIOUS HEALTH AND HOSPICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NZELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-688-7990
Mailing Address - Street 1:5716 EDINBURG DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2886
Mailing Address - Country:US
Mailing Address - Phone:469-688-7990
Mailing Address - Fax:
Practice Address - Street 1:5716 EDINBURG DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2886
Practice Address - Country:US
Practice Address - Phone:469-688-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based