=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194634519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACIOUS BY YOUR SIDE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2026
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35675 GARNER ST
-----------------------------------------------------
City | ROMULUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48174-4129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-308-7991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35675 GARNER ST
-----------------------------------------------------
City | ROMULUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48174-4129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-308-7991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO,MANAGER
-----------------------------------------------------
Name | SHAWNA DIETRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-308-7991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------