Provider Demographics
NPI:1144759259
Name:GRACIOUS LOVING HOME CARE LLC
Entity Type:Organization
Organization Name:GRACIOUS LOVING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-972-2808
Mailing Address - Street 1:2151 E HIGH ST STE B
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3289
Mailing Address - Country:US
Mailing Address - Phone:610-268-7797
Mailing Address - Fax:610-500-5013
Practice Address - Street 1:2151 E HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3289
Practice Address - Country:US
Practice Address - Phone:610-268-7797
Practice Address - Fax:610-500-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32963601Medicaid