Healthcare Provider Details

I. General information

NPI: 1093215329
Provider Name (Legal Business Name): GRACIOUS LOVE HOME HEALHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BLUE STEM APT 28106
PROSPER TX
75078-1781
US

IV. Provider business mailing address

4500 BLUE STEM APT 28106
PROSPER TX
75078-1781
US

V. Phone/Fax

Practice location:
  • Phone: 469-207-6436
  • Fax:
Mailing address:
  • Phone: 469-207-6436
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. TALISE CHANTEL GOLLIDAY
Title or Position: OWNER
Credential:
Phone: 469-207-6436