=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528948361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACEFULLY LIVING HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2025
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 CHERRYWOOD CT
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-325-0649
-----------------------------------------------------
Fax | 757-325-0649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4020 CHERRYWOOD CT
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-325-0649
-----------------------------------------------------
Fax | 757-325-0649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. WALTER DANIEL HOOPER III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-325-0649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------