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General NPI Number Information
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NPI Number | 1528792199
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Entity Type | Organization
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Legal Business Name | GRACEFULLY EXTENDED LLC
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 3203 CONWAY RD STE 200-C
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City | ORLANDO
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State | FL
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Zip | 32812-7303
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Country | US
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Telephone | 877-977-1433
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Fax |
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Provider Business Mailing Address
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Address Line | 3203 CONWAY RD STE 200-C
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City | ORLANDO
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State | FL
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Zip | 32812-7303
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Country | US
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Telephone | 877-977-1433
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. ARYELLE ROBERTSON
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Credential |
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Telephone | 561-506-5348
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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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