Provider Demographics
NPI:1649824715
Name:GRACEFUL ARMS SENIOR LIVING LLC
Entity type:Organization
Organization Name:GRACEFUL ARMS SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-297-0430
Mailing Address - Street 1:1415 BIG STONE GAP RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2003
Mailing Address - Country:US
Mailing Address - Phone:469-297-0430
Mailing Address - Fax:469-776-5200
Practice Address - Street 1:1415 BIG STONE GAP RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2003
Practice Address - Country:US
Practice Address - Phone:469-297-0430
Practice Address - Fax:469-776-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106818OtherTEXAS STATE ASSISTED LIVING VENDOR/FACILITY ID