Provider Demographics
NPI:1376147538
Name:GRACIOUS HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:GRACIOUS HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AKERIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BETSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:850-728-2677
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32353-0821
Mailing Address - Country:US
Mailing Address - Phone:850-728-2677
Mailing Address - Fax:
Practice Address - Street 1:3034 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-6003
Practice Address - Country:US
Practice Address - Phone:850-728-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237257OtherAGENCY FOR HEALTHCARE ADMINISTRATION