MEDICARE: GRACIOUS HOME HEALTH SERVICES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417412453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIOUS HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1514 ROSE TER
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-4726
Country	:	US
Telephone Number	:	908-810-1044
Fax Number	:	908-810-1077

Provider Business Practice Location Address
First Line	:	2165 MORRIS AVE STE 19
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5913
Country	:	US
Telephone Number	:	908-810-1044
Fax Number	:	908-810-1077

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MRS. ESTHER AGBONMA EWEH
Credential	:	RN BSN
Telephone Number	:	908-810-1044

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/04/2019

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