Healthcare Provider Details

I. General information

NPI: 1053235986
Provider Name (Legal Business Name): GRACEFUL VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 CLARK FARM RD
CHARLOTTE NC
28213-1404
US

IV. Provider business mailing address

3421 CLARK FARM RD
CHARLOTTE NC
28213-1404
US

V. Phone/Fax

Practice location:
  • Phone: 704-488-9839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLI HILL
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 704-488-9839