Provider Demographics
NPI:1659818235
Name:EZ GRACE RESIDENTIAL HOME CARE
Entity type:Organization
Organization Name:EZ GRACE RESIDENTIAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-478-0095
Mailing Address - Street 1:919 SADDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1630
Mailing Address - Country:US
Mailing Address - Phone:210-994-8210
Mailing Address - Fax:
Practice Address - Street 1:919 SADDLEBROOK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1630
Practice Address - Country:US
Practice Address - Phone:210-994-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106661310400000X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility