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General NPI Number Information
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NPI Number | 1427314905
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Entity Type | Organization
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Legal Business Name | GRACELAND HOME HEALTH CARE &SUPPORTED LIVING
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 1756 STILTON AVE
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City | COLUMBUS
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State | OH
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Zip | 43228-4574
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Country | US
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Telephone | 614-772-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 1756 STILTON AVE
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City | COLUMBUS
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State | OH
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Zip | 43228-4574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUGIATOU JALLOW
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Credential |
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Telephone | 614-772-8700
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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 | 201204700701
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License Number State | OH
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