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General NPI Number Information
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NPI Number | 1104387364
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Entity Type | Organization
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Legal Business Name | GRACEFUL HANDS PERSONAL CARE AGENCY LLC
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 1700 WESTLAWN AVE
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City | RACINE
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State | WI
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Zip | 53405-3878
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Country | US
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Telephone | 262-583-1660
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Fax | 262-770-3150
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Provider Business Mailing Address
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Address Line | 3054 ERIE ST
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City | RACINE
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State | WI
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Zip | 53402-4037
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Country | US
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Telephone | 262-902-4147
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MARSHA LYNN JONES
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Credential |
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Telephone | 262-583-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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