Provider Demographics
NPI:1487439386
Name:GRACE CLINIC
Entity type:Organization
Organization Name:GRACE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:713-417-0479
Mailing Address - Street 1:3502 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-6243
Mailing Address - Country:US
Mailing Address - Phone:713-417-0479
Mailing Address - Fax:
Practice Address - Street 1:3502 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-6243
Practice Address - Country:US
Practice Address - Phone:713-417-0479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care