Organization
GRACE INDEPENDENT HOME CARE, INC.
Active
Other names
OneSource Home Care Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN FORD (ADMINISTRATOR)
(903) 248-2530
Entity
Organization
Contact information
Practice address
4002 TECHNOLOGY CTR, LONGVIEW, TX 75605
(903) 248-2530
(903) 248-2538
Mailing address
4002 TECHNOLOGY CTR, LONGVIEW, TX 75605-2697
(903) 248-2530
(903) 248-2538
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
007854
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104147339
NPI
—
05
—
153380401
—
TX
01
—
HH565H
BLUE CROSSBLUE SHIELD
TX
Enumeration date
12/06/2005
Last updated
08/06/2020
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