MEDICARE: GRACEFUL 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1548092687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL CARE LLC

Provider Business Mailing Address
First Line	:	1500 PARK CENTER DR STE 230
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5708
Country	:	US
Telephone Number	:	407-307-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 PARK CENTER DR STE 230
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5708
Country	:	US
Telephone Number	:	407-307-4821
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	IMONIE PATRICK
Credential	:
Telephone Number	:	407-307-4821

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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Directions to “GRACEFUL CARE LLC ” Practice Location

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