Healthcare Provider Details

I. General information

NPI: 1376136465
Provider Name (Legal Business Name): GRACEFUL FAMILY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 MILLENIA BLVD APT 305
ORLANDO FL
32839-5657
US

IV. Provider business mailing address

5040 MILLENIA BLVD APT 305
ORLANDO FL
32839-5657
US

V. Phone/Fax

Practice location:
  • Phone: 321-527-1814
  • Fax:
Mailing address:
  • Phone: 321-527-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS EMMANUELA PIERRE
Title or Position: OWNER
Credential:
Phone: 321-527-1814