Healthcare Provider Details

I. General information

NPI: 1073483152
Provider Name (Legal Business Name): GRACIOUS LIFE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SOUTH AVE STE 204
POUGHKEEPSIE NY
12601-4836
US

IV. Provider business mailing address

201 SOUTH AVE STE 204
POUGHKEEPSIE NY
12601-4836
US

V. Phone/Fax

Practice location:
  • Phone: 646-420-9805
  • Fax:
Mailing address:
  • Phone: 646-420-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUDITH ADJEI
Title or Position: CEO
Credential: FNP
Phone: 646-420-9805