Healthcare Provider Details

I. General information

NPI: 1972164523
Provider Name (Legal Business Name): STAY GRACEFUL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 W MAIN ST # 208
RAPID CITY SD
57702-2564
US

IV. Provider business mailing address

3115 STOCKADE DR
RAPID CITY SD
57702-5065
US

V. Phone/Fax

Practice location:
  • Phone: 605-679-7829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JESSICA OLSON
Title or Position: CEO
Credential:
Phone: 605-679-7829