Healthcare Provider Details

I. General information

NPI: 1831033703
Provider Name (Legal Business Name): GRACIOUS HEARTS HOME CARE OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST # 8259
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST # 8259
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 928-222-2250
  • Fax: 713-383-6438
Mailing address:
  • Phone: 928-222-2250
  • Fax: 713-383-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SHAMEKA IDUSUYI
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-222-2250