MEDICARE: GRACIOUS LIVING HOME CARE

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	:	1629442207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIOUS LIVING HOME CARE

Provider Business Mailing Address
First Line	:	13340 80TH LN N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2663
Country	:	US
Telephone Number	:	954-588-0202
Fax Number	:	561-508-7089

Provider Business Practice Location Address
First Line	:	13340 80TH LN N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2663
Country	:	US
Telephone Number	:	954-588-0202
Fax Number	:	561-508-7089

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DOREEN A PHOENIX
Credential	:
Telephone Number	:	954-588-0202

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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