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General NPI Number Information
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NPI Number | 1417375908
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Entity Type | Organization
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Legal Business Name | GRACIOUSLY CREATIVE CARE, LLC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 8595 BEECHMONT AVE SUITE LL3
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City | CINCINNATI
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State | OH
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Zip | 45255-4783
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Country | US
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Telephone | 513-536-6337
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Fax | 513-536-8731
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Provider Business Mailing Address
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Address Line | 8595 BEECHMONT AVE SUITE LL3
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City | CINCINNATI
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State | OH
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Zip | 45255-4783
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Country | US
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Telephone | 513-536-6337
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Fax | 513-536-8731
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Authorized Official
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Title or Position | MEMBER
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Name | IJEOMA JESSICA AJUNWA
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Credential |
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Telephone | 513-536-6399
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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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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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