MEDICARE: GRACIOUS HOME HEALTH CARE 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	:	1700341575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIOUS HOME HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1226 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:	215-883-1616
Fax Number	:	215-883-1511

Provider Business Practice Location Address
First Line	:	1226 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:	215-883-1616
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EUGENIA N AZODO
Credential	:
Telephone Number	:	215-883-1616

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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