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General NPI Number Information
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NPI Number | 1629442207
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Entity Type | Organization
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Legal Business Name | GRACIOUS LIVING HOME CARE
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 13340 80TH LN N
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-2663
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Country | US
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Telephone | 954-588-0202
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Fax | 561-508-7089
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Provider Business Mailing Address
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Address Line | 13340 80TH LN N
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-2663
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Country | US
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Telephone | 954-588-0202
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Fax | 561-508-7089
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DOREEN A PHOENIX
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Credential |
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Telephone | 954-588-0202
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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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