Healthcare Provider Details

I. General information

NPI: 1255703112
Provider Name (Legal Business Name): GRACIOUS SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LENOX AVE SUITE 353
WESTFIELD NJ
07090-5120
US

IV. Provider business mailing address

208 LENOX AVE SUITE 353
WESTFIELD NJ
07090-5120
US

V. Phone/Fax

Practice location:
  • Phone: 908-759-8266
  • Fax:
Mailing address:
  • Phone: 908-759-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. BAMIDELE A BADMUS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 908-759-8266