Provider Demographics
NPI:1760200810
Name:GRACE BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:GRACE BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCHOLASTICA
Authorized Official - Middle Name:OYIBO
Authorized Official - Last Name:ONYEMMA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-992-1703
Mailing Address - Street 1:1801 N HAMPTON RD STE 425
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2491
Mailing Address - Country:US
Mailing Address - Phone:469-992-1703
Mailing Address - Fax:
Practice Address - Street 1:1801 N HAMPTON RD STE 425
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2491
Practice Address - Country:US
Practice Address - Phone:469-992-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty