NE Health of Grapevine LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

NE HEALTH OF GRAPEVINE LLC

Practice address

3729 Ira E Woods Ave
Grapevine, TX 76051-4213

Phone

(817) 809-8000

NPI assigned

Nov 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Siobaughn Fraser

Title

Authorized Representative

Phone

(561) 801-4235

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606435200000",
    "number": "1124622451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 US HIGHWAY 1 STE 200",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334084415",
            "telephone_number": "561-801-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3729 IRA E WOODS AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760514213",
            "telephone_number": "817-809-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NE HEALTH OF GRAPEVINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-27",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "SIOBAUGHN",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "561-801-4235"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.