Healthcare Provider Details

I. General information

NPI: 1578032967
Provider Name (Legal Business Name): GRACEFULLY AGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 LOCHSHYRE LOOP
OCOEE FL
34761-9160
US

IV. Provider business mailing address

1837 LOCHSHYRE LOOP
OCOEE FL
34761-9160
US

V. Phone/Fax

Practice location:
  • Phone: 407-844-5840
  • 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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: NAKIA STARKER
Title or Position: MANAGER
Credential:
Phone: 407-844-5840