Provider Demographics
NPI:1407634728
Name:GRACELAND HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:GRACELAND HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHATOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-809-9810
Mailing Address - Street 1:2610 EASTBURN CTR UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7285
Mailing Address - Country:US
Mailing Address - Phone:302-533-7359
Mailing Address - Fax:
Practice Address - Street 1:2610 EASTBURN CTR UNIT B
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7285
Practice Address - Country:US
Practice Address - Phone:302-533-7359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care