Provider Demographics
NPI:1013212521
Name:GRACEFUL NURSE'S LLC
Entity Type:Organization
Organization Name:GRACEFUL NURSE'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:NYUYKI
Authorized Official - Last Name:ADEMBUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-593-1547
Mailing Address - Street 1:1836 METZEROTT RD
Mailing Address - Street 2:SUITE 1425
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3475
Mailing Address - Country:US
Mailing Address - Phone:240-593-1547
Mailing Address - Fax:301-755-5945
Practice Address - Street 1:1836 METZEROTT RD
Practice Address - Street 2:SUITE 1425
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3475
Practice Address - Country:US
Practice Address - Phone:240-593-1547
Practice Address - Fax:301-755-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251J00000X251J00000X
MD253Z00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care