MEDICARE: GRACEFUL AGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246RP1900X	Phlebotomy Technician
2	363LA2200X	Adult Health Nurse Practitioner
3	163WW0000X	Wound Care Registered Nurse
4	363LG0600X	Gerontology Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053883306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL AGING LLC

Provider Business Mailing Address
First Line	:	PO BOX 13426
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88013-3426
Country	:	US
Telephone Number	:	575-203-1477
Fax Number	:	575-888-2444

Provider Business Practice Location Address
First Line	:	2707 SPITZ ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1338
Country	:	US
Telephone Number	:	575-203-1477
Fax Number	:	575-888-2444

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. AMY ELISE LOPEZ
Credential	:	DNP
Telephone Number	:	575-621-3390

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	03/09/2026

Similar Medicare Providers

1841830981 — BLUE HORIZON PROPERTIES, LLC
Practice Location Address:

2707 SPITZ ST
LAS CRUCES, NM
88005-1338

Practice Phone: 505-269-4556
Practice Fax: 800-557-3574

1316197817 — DR. SHARON MIA KIM D.D.S., M.S.
Practice Location Address:

150 E CENTENNIAL PKWY STE 113
NORTH LAS VEGAS, NV
89084-1338

Practice Phone: 702-642-1386
Practice Fax:

1356640197 — JOHN ARMSTRONG
Practice Location Address:

6160 N CONQUISTADOR ST
LAS VEGAS, NV
89149-1338

Practice Phone: 702-860-7450
Practice Fax:

1861852568 — HEIDI UNGER
Practice Location Address:

14050 KYLE CANYON RD
LAS VEGAS, NV
89166-1338

Practice Phone: 702-395-1519
Practice Fax: 702-395-2850

1093178832 — HEIDI SUE UNGER
Practice Location Address:

14050 KYLE CANYON RD
LAS VEGAS, NV
89166-1338

Practice Phone: 702-395-1519
Practice Fax: 702-395-2850

1629668140 — ROCKINGHRANCH JDT LLC
Practice Location Address:

14050 KYLE CANYON RD
LAS VEGAS, NV
89166-1338

Practice Phone: 702-301-5705
Practice Fax:

Directions to “GRACEFUL AGING LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.