MEDICARE: GRACIOUS SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251E00000X	Home Health Agency
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
4	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1255703112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIOUS SERVICES INC.

Provider Business Mailing Address
First Line	:	208 LENOX AVE
Second Line	:	SUITE 353
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-5120
Country	:	US
Telephone Number	:	908-759-8266
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 LENOX AVE
Second Line	:	SUITE 353
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-5120
Country	:	US
Telephone Number	:	908-759-8266
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. BAMIDELE A BADMUS
Credential	:
Telephone Number	:	908-759-8266

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	09/05/2024

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