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General NPI Number Information
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NPI Number | 1629961669
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Entity Type | Organization
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Legal Business Name | GRACIOUS DIVINE HOME CARE LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 900 GRANBY ST STE 201
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City | NORFOLK
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State | VA
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Zip | 23510-2567
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Country | US
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Telephone | 757-581-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 E PRINCESS ANNE RD APT 5
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City | NORFOLK
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State | VA
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Zip | 23502-1547
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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 | BLESSYN BLOWE
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Credential |
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Telephone | 757-581-2818
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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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