MEDICARE: GRACEFUL CARE AGENCY, INC

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	:	1578368775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL CARE AGENCY, INC

Provider Business Mailing Address
First Line	:	2434 BRATTON AVE
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0418
Country	:	US
Telephone Number	:	248-227-2075
Fax Number	:

Provider Business Practice Location Address
First Line	:	2434 BRATTON AVE
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0418
Country	:	US
Telephone Number	:	248-227-2075
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AUJEAN SHAMMAMI
Credential	:
Telephone Number	:	248-227-2075

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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