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General NPI Number Information
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NPI Number | 1558919613
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Entity Type | Organization
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Legal Business Name | GRACEFUL CAME IN HOME LLC
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 600 CAPITOL BLVD
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City | ELKHART
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State | IN
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Zip | 46516-4056
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Country | US
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Telephone | 574-524-6573
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Fax | 314-338-4911
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Provider Business Mailing Address
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Address Line | 600 CAPITOL BLVD
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City | ELKHART
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State | IN
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Zip | 46516-4056
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Country | US
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Telephone | 574-524-6573
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Fax | 314-338-4911
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAURICE HENDRICKS
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Credential |
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Telephone | 314-853-9312
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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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