Healthcare Provider Details

I. General information

NPI: 1437515954
Provider Name (Legal Business Name): GRACIOUS TOUCH HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3446 GLEN ELLEN DR
FAIRFIELD CA
94534-7959
US

IV. Provider business mailing address

3446 GLEN ELLEN DR
FAIRFIELD CA
94534-7959
US

V. Phone/Fax

Practice location:
  • Phone: 707-712-0598
  • Fax:
Mailing address:
  • Phone: 707-712-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number201527310416
License Number StateCA

VIII. Authorized Official

Name: MR. LAWRENCE E NWAKI
Title or Position: CEO
Credential: RN,BS,MPA
Phone: 707-712-0598