DIVINE GRACE FAMILY CLINIC INC


Address: 2455 Robinson Rd Ste 100, Grand Prairie, TX 75051-3852
Phone: 4696600032

DIVINE GRACE FAMILY CLINIC INC (NPI# 1386255065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1386255065
Entity Type Organization
Organization Name DIVINE GRACE FAMILY CLINIC INC
Practice Address 2455 Robinson Rd Ste 100
Grand Prairie
TX 75051-3852
Practice Telephone 4696600032
Mailing Telephone 4696600032
Enumeration Date 2020-08-14
Last Update Date 2020-08-14
Authorized Official Name DR. ETHEL BUBU (OWNER/ADMINISTRATOR)
Authorized Official Telephone 2143259254
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QH0100X Clinic/Center
Specialization: Health Service
Ambulatory Health Care Facilities

Office Location

Street Address 2455 ROBINSON RD STE 100
City GRAND PRAIRIE
State TX
Zip Code 75051-3852

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Taxonomy Information

Taxonomy Code 261QH0100X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Health Service

Taxonomy Definition

Definition to come...
Notes: [7/1/2006: modified title]

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Competitor

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City GRAND PRAIRIE
Zip Code 75051

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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