Healthcare Provider Details

I. General information

NPI: 1912822578
Provider Name (Legal Business Name): GRACEFUL PERSONALCARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 BUENA VISTA RD
COLUMBUS GA
31907-5108
US

IV. Provider business mailing address

5124 BUENA VISTA RD
COLUMBUS GA
31907-5108
US

V. Phone/Fax

Practice location:
  • Phone: 706-587-3302
  • Fax: 844-808-0440
Mailing address:
  • Phone: 706-587-3302
  • Fax: 844-808-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ROSIE B WASHINGTON
Title or Position: OWNER
Credential:
Phone: 706-587-3302