Healthcare Provider Details

I. General information

NPI: 1275420721
Provider Name (Legal Business Name): GRACEFUL AGING HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N SPRING ST
WINSTON SALEM NC
27101-2722
US

IV. Provider business mailing address

326 N SPRING ST
WINSTON SALEM NC
27101-2722
US

V. Phone/Fax

Practice location:
  • Phone: 336-413-7907
  • Fax: 336-448-0061
Mailing address:
  • Phone: 336-413-7907
  • Fax: 336-448-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JONAY R HOWARD
Title or Position: CEO
Credential:
Phone: 336-413-7907