Provider Demographics
NPI:1417412453
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:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:AGBONMA
Authorized Official - Last Name:EWEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:908-810-1044
Mailing Address - Street 1:1514 ROSE TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4726
Mailing Address - Country:US
Mailing Address - Phone:908-810-1044
Mailing Address - Fax:908-810-1077
Practice Address - Street 1:2165 MORRIS AVE STE 19
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5913
Practice Address - Country:US
Practice Address - Phone:908-810-1044
Practice Address - Fax:908-810-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health