Healthcare Provider Details

I. General information

NPI: 1588420327
Provider Name (Legal Business Name): GRACEFULLY WITH AGE HEALTHCARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S. 4TH STREET
DARBY PA
19023-3119
US

IV. Provider business mailing address

503 S. 4TH STREET
DARBY PA
19023-3119
US

V. Phone/Fax

Practice location:
  • Phone: 484-948-8829
  • Fax:
Mailing address:
  • Phone: 484-948-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MALVENIA AVERY
Title or Position: PRESIDENT
Credential:
Phone: 484-948-8829