Healthcare Provider Details

I. General information

NPI: 1194634519
Provider Name (Legal Business Name): GRACIOUS BY YOUR SIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

35675 GARNER ST
ROMULUS MI
48174-4129
US

IV. Provider business mailing address

35675 GARNER ST
ROMULUS MI
48174-4129
US

V. Phone/Fax

Practice location:
  • Phone: 810-308-7991
  • Fax:
Mailing address:
  • Phone: 810-308-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA DIETRICK
Title or Position: CEO,MANAGER
Credential:
Phone: 810-308-7991