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General NPI Number Information
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NPI Number | 1174088827
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Entity Type | Organization
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Legal Business Name | GRACEFULLY AGING LLC
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1837 LOCHSHYRE LOOP
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City | OCOEE
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State | FL
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Zip | 34761-9160
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Country | US
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Telephone | 407-744-9043
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Fax |
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Provider Business Mailing Address
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Address Line | 1837 LOCHSHYRE LOOP
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City | OCOEE
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State | FL
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Zip | 34761-9160
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Country | US
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Telephone | 407-744-9043
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NAKIA STARKER
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Credential |
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Telephone | 407-844-5840
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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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