Healthcare Provider Details

I. General information

NPI: 1417375908
Provider Name (Legal Business Name): GRACIOUSLY CREATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 BEECHMONT AVE SUITE LL3
CINCINNATI OH
45255-4783
US

IV. Provider business mailing address

8595 BEECHMONT AVE SUITE LL3
CINCINNATI OH
45255-4783
US

V. Phone/Fax

Practice location:
  • Phone: 513-536-6337
  • Fax: 513-536-8731
Mailing address:
  • Phone: 513-536-6337
  • Fax: 513-536-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IJEOMA JESSICA AJUNWA
Title or Position: MEMBER
Credential:
Phone: 513-536-6399