MEDICARE: GRACIOUS CARE HOME HEALTH SERVICES, 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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1679799118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIOUS CARE HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	7111 GARDEN GROVE BLVD STE 207
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92841-4296
Country	:	US
Telephone Number	:	714-925-4654
Fax Number	:	714-373-9304

Provider Business Practice Location Address
First Line	:	7111 GARDEN GROVE BLVD STE 207
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92841-4296
Country	:	US
Telephone Number	:	714-925-4654
Fax Number	:	714-373-9304

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS CHRISTINE T. HUYNH
Credential	:
Telephone Number	:	714-925-4654

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	10/22/2007

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