Healthcare Provider Details

I. General information

NPI: 1689034845
Provider Name (Legal Business Name): GRACIOUS HEART NURSING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 WESTVILLE RD
MARYDEL DE
19964-2026
US

IV. Provider business mailing address

1884 WESTVILLE RD
MARYDEL DE
19964-2026
US

V. Phone/Fax

Practice location:
  • Phone: 302-343-9083
  • Fax:
Mailing address:
  • Phone: 302-343-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberL10019326
License Number StateDE

VIII. Authorized Official

Name: SHARON BURTON-YOUNG
Title or Position: OWNER/DIRECTOR
Credential: RN, CRNI
Phone: 302-423-2511