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General NPI Number Information
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NPI Number | 1689390809
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Entity Type | Organization
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Legal Business Name | GRACIOUS GROUP CARE AGENCY,LLC
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 449 W CENTENNIAL ST
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City | SPARTANBURG
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State | SC
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Zip | 29303-2767
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Country | US
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Telephone | 864-444-0493
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Fax | 864-450-9060
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Provider Business Mailing Address
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Address Line | 2 MEADOW SPRINGS LN
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City | GREER
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State | SC
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Zip | 29650-1005
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Country | US
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Telephone | 864-444-0493
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Fax | 864-450-9060
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. EMMANUEL IGWE
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Credential | PHD
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Telephone | 864-444-0493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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