Healthcare Provider Details

I. General information

NPI: 1861381733
Provider Name (Legal Business Name): GRACEFIELD HOME CARE OF NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111E ROSE LAKE DR # 8334
CHARLOTTE NC
28217-2858
US

IV. Provider business mailing address

207 E 91ST ST APT 3C
BROOKLYN NY
11212-1320
US

V. Phone/Fax

Practice location:
  • Phone: 919-694-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA MITCHELL CASSEUS
Title or Position: PRESIDENT
Credential:
Phone: 919-694-4700