Healthcare Provider Details

I. General information

NPI: 1013212521
Provider Name (Legal Business Name): GRACEFUL NURSE'S LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 METZEROTT RD SUITE 1425
ADELPHI MD
20783-3475
US

IV. Provider business mailing address

1836 METZEROTT RD SUITE 1425
ADELPHI MD
20783-3475
US

V. Phone/Fax

Practice location:
  • Phone: 240-593-1547
  • Fax: 301-755-5945
Mailing address:
  • Phone: 240-593-1547
  • Fax: 301-755-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number251J00000X
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number253Z00000X
License Number StateMD

VIII. Authorized Official

Name: MRS. GRACE NYUYKI ADEMBUH
Title or Position: OWNER
Credential:
Phone: 240-593-1547