Organization
ETERNAL GRACE RELATIONAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYLYNN BROWN (OWNER)
(512) 415-1359
Entity
Organization
Contact information
Practice address
101 JONATHAN DR UNIT 3, LIBERTY HILL, TX 78642-6358
(512) 277-0676
Mailing address
101 JONATHAN DR UNIT 3, LIBERTY HILL, TX 78642-6358
(512) 277-0676
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
804105581
CERTIFICATE OF FILING
TX
Enumeration date
07/20/2021
Last updated
07/20/2021
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