Grace Quality Grouphome LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

GRACE QUALITY GROUPHOME LLC

Practice address

5900 Ember Glen Dr
Haltom City, TX 76137-5809

Phone

(682) 301-2042

NPI assigned

Nov 18, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Cassandra Delissaint

Title

Group Home Manager

Phone

(682) 301-2042

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1407399751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 EMBER GLEN DR",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761375809",
            "telephone_number": "682-301-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 EMBER GLEN DR",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761375809",
            "telephone_number": "682-301-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE QUALITY GROUPHOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "DELISSAINT",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "GROUP HOME MANAGER",
        "authorized_official_telephone_number": "682-301-2042",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Haltom City, TX
• Providers in Haltom City, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; 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.