Provider Demographics
NPI:1699985432
Name:GRACELAND PERSONAL CARE HOMES, INC
Entity type:Organization
Organization Name:GRACELAND PERSONAL CARE HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-692-1976
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:2625 CR 302
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-0329
Mailing Address - Country:US
Mailing Address - Phone:903-693-9617
Mailing Address - Fax:903-694-9191
Practice Address - Street 1:1315 SPRING ST
Practice Address - Street 2:2625 CR 302
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2061
Practice Address - Country:US
Practice Address - Phone:903-693-9617
Practice Address - Fax:903-694-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030117310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility