Healthcare Provider Details

I. General information

NPI: 1679484679
Provider Name (Legal Business Name): GRACIOUS GENERATIONS HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 N 10TH ST STE A
PHILADELPHIA PA
19140-3123
US

IV. Provider business mailing address

3730 N 10TH ST STE A
PHILADELPHIA PA
19140-3123
US

V. Phone/Fax

Practice location:
  • Phone: 267-516-1741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHATOYA T HAILE
Title or Position: PRESIDENT
Credential:
Phone: 267-516-1741