Healthcare Provider Details

I. General information

NPI: 1003798976
Provider Name (Legal Business Name): GRACIOUS HOME ADULT DAY HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 TURNPIKE RD STE 101
SOUTHBOROUGH MA
01772-1760
US

IV. Provider business mailing address

337 TURNPIKE RD STE 101
SOUTHBOROUGH MA
01772-1760
US

V. Phone/Fax

Practice location:
  • Phone: 718-607-5612
  • Fax:
Mailing address:
  • Phone: 718-607-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEI JING
Title or Position: MANAGER
Credential:
Phone: 718-607-5612