Provider Demographics
NPI:1699557694
Name:GRACE IN HEALINGS PLLC
Entity type:Organization
Organization Name:GRACE IN HEALINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRAJNAWATI
Authorized Official - Middle Name:
Authorized Official - Last Name:WIBOWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-215-1691
Mailing Address - Street 1:5301 ALPHA RD STE 80-3
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4355
Mailing Address - Country:US
Mailing Address - Phone:682-215-1691
Mailing Address - Fax:682-267-4840
Practice Address - Street 1:5301 ALPHA RD STE 80-3
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4355
Practice Address - Country:US
Practice Address - Phone:682-215-1691
Practice Address - Fax:682-267-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty