Organization
HOUSE OF GRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANIS FERN GRAY (CO-ADMINASTRATOR)
(254) 699-4500
Entity
Organization
Contact information
Practice address
2207 WICKIUP TRL, HARKER HEIGHTS, TX 76548-2082
(254) 699-4500
Mailing address
PO BOX 2755, HARKER HEIGHTS, TX 76548-0755
(254) 699-4500
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3691 A
HCS
—
Enumeration date
01/23/2013
Last updated
01/23/2013
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