Healthcare Provider Details

I. General information

NPI: 1154078178
Provider Name (Legal Business Name): GRACEFUL HANDS FAMILY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 HARRY C RAYSOR DR
ST MATTHEWS SC
29135-1481
US

IV. Provider business mailing address

PO BOX 332
ST MATTHEWS SC
29135-0332
US

V. Phone/Fax

Practice location:
  • Phone: 804-901-9907
  • Fax:
Mailing address:
  • Phone: 803-901-9907
  • 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: SONJA MACK
Title or Position: ADMINISTRATION
Credential:
Phone: 803-901-9907