Provider Demographics
NPI:1588312185
Name:GRACEHILL SENIOR LIVING HOME
Entity type:Organization
Organization Name:GRACEHILL SENIOR LIVING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:NNAEMEKA
Authorized Official - Last Name:AWUZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-931-3812
Mailing Address - Street 1:5720 BANDERA RD STE 21
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1985
Mailing Address - Country:US
Mailing Address - Phone:210-931-3812
Mailing Address - Fax:
Practice Address - Street 1:5720 BANDERA RD STE 21
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1985
Practice Address - Country:US
Practice Address - Phone:210-931-3812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine