Provider Demographics
NPI:1841477643
Name:GRACENELLY SERVICES INC.
Entity type:Organization
Organization Name:GRACENELLY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANUNOBINWAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-632-3411
Mailing Address - Street 1:1405 COTTONWOOD VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6102
Mailing Address - Country:US
Mailing Address - Phone:214-632-3411
Mailing Address - Fax:
Practice Address - Street 1:1405 COTTONWOOD VALLEY CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6102
Practice Address - Country:US
Practice Address - Phone:214-632-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services