Provider Demographics
NPI:1487115721
Name:GRACE EXTENDED RESIDENTIAL ASSISTED LIVING
Entity type:Organization
Organization Name:GRACE EXTENDED RESIDENTIAL ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-685-8189
Mailing Address - Street 1:223 WILLARDS WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5844
Mailing Address - Country:US
Mailing Address - Phone:281-685-8189
Mailing Address - Fax:
Practice Address - Street 1:9018 COVENT GARDEN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3016
Practice Address - Country:US
Practice Address - Phone:713-988-2029
Practice Address - Fax:713-988-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility