Healthcare Provider Details

I. General information

NPI: 1457040255
Provider Name (Legal Business Name): GRACEFUL JOURNEY COMPANION AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/06/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SOUTHERN CROSS CIR APT 205
BOYNTON BEACH FL
33436-6786
US

IV. Provider business mailing address

17 SOUTHERN CROSS CIR APT 205
BOYNTON BEACH FL
33436-6786
US

V. Phone/Fax

Practice location:
  • Phone: 561-668-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: JUDY GASSANT
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-668-3334