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General NPI Number Information
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NPI Number | 1679328850
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Entity Type | Organization
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Legal Business Name | GRACEFUL LIVING IN HOME CARE, LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 135 E MAIN ST STE 212
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City | ROCK HILL
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State | SC
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Zip | 29730-4892
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Country | US
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Telephone | 803-973-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 135 E MAIN ST STE 212
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City | ROCK HILL
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State | SC
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Zip | 29730-4892
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Country | US
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Telephone | 803-973-6060
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANTONDE TYESE CRAWFORD
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Credential |
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Telephone | 803-320-5313
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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