Healthcare Provider Details

I. General information

NPI: 1528948361
Provider Name (Legal Business Name): GRACEFULLY LIVING HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 CHERRYWOOD CT
CHESAPEAKE VA
23321-3342
US

IV. Provider business mailing address

4020 CHERRYWOOD CT
CHESAPEAKE VA
23321-3342
US

V. Phone/Fax

Practice location:
  • Phone: 757-325-0649
  • Fax: 757-325-0649
Mailing address:
  • Phone: 757-325-0649
  • Fax: 757-325-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER DANIEL HOOPER III
Title or Position: MANAGER
Credential:
Phone: 757-325-0649