Provider Demographics
NPI:1093177487
Name:GRACEFULL, LLC
Entity Type:Organization
Organization Name:GRACEFULL, LLC
Other - Org Name:PREMIER HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-231-0435
Mailing Address - Street 1:7400 LOUIS PASTEUR DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4510
Mailing Address - Country:US
Mailing Address - Phone:210-231-0435
Mailing Address - Fax:210-231-0440
Practice Address - Street 1:7400 LOUIS PASTEUR DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4510
Practice Address - Country:US
Practice Address - Phone:210-231-0435
Practice Address - Fax:210-231-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health