MEDICARE: GRACEFUL HANDS OF COMPASSION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083378244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL HANDS OF COMPASSION LLC

Provider Business Mailing Address
First Line	:	2402 PALM AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4504
Country	:	US
Telephone Number	:	863-512-6557
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 PALM AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4504
Country	:	US
Telephone Number	:	863-512-6557
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIA HAMPTON
Credential	:
Telephone Number	:	863-512-6557

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	05/23/2022

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