MEDICARE: GRACEFUL ANGELS HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1184554180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL ANGELS HOME CARE LLC

Provider Business Mailing Address
First Line	:	3556 WALES DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1843
Country	:	US
Telephone Number	:	317-742-3415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3556 WALES DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1843
Country	:	US
Telephone Number	:	317-742-3415
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OLIVE MAHORO
Credential	:
Telephone Number	:	317-742-3415

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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