Healthcare Provider Details

I. General information

NPI: 1437998069
Provider Name (Legal Business Name): GRACEFUL AGING HOME CARE LLC; DBA NURSE NEXT DOOR SALEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 LIBERTY ST SE STE A&D
SALEM OR
97302-4369
US

IV. Provider business mailing address

1435 LIBERTY ST SE STE A&D
SALEM OR
97302-4369
US

V. Phone/Fax

Practice location:
  • Phone: 971-241-1782
  • Fax:
Mailing address:
  • Phone: 971-241-1782
  • Fax:

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

VIII. Authorized Official

Name: DEVIKA RAM
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 971-241-1782