Grace Independent Home Care, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

007854 Issued in TX

Legal business name

GRACE INDEPENDENT HOME CARE, INC.

Practice address

4002 Technology Ctr
Longview, TX 75605

Phone

(903) 248-2530

Fax

(903) 248-2538

NPI assigned

Dec 6, 2005

Organization subpart

No

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

Authorized official

Name

John Ford

Title

Administrator

Phone

(903) 248-2530

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• OneSource Home Care Inc Other name

Locations

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1245214873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 TECHNOLOGY CTR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052697",
            "telephone_number": "903-248-2530",
            "fax_number": "903-248-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 TECHNOLOGY CTR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-248-2530",
            "fax_number": "903-248-2538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2615 E End Blvd S",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756727425",
            "country_code": "US",
            "telephone_number": "903-927-1186",
            "fax_number": "903-927-1189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACE INDEPENDENT HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-248-2530"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "007854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1104147339",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153380401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSSBLUE SHIELD",
            "identifier": "HH565H",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OneSource Home Care Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Destiny Deon Gordy, LPC
• Tony Eugene Goss, LPC-A
• Jason Robert Gough, MS PT CBIS
• Sarah E Gough, NP
• Jason Goza
• Grace Neurology Clinic, PLLC
• Timothy Eugene Graham, M.D.
• Jessica Gramling
• Brandy Nichole Gramse, RN
• Julie Dianne Grant, M.S., CCC-SLP

• Home Health Agency in Longview, TX
• Providers in Longview, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.