Provider Demographics
NPI:1477278117
Name:GRACEFUL HOME CARE LLC
Entity Type:Organization
Organization Name:GRACEFUL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-616-9781
Mailing Address - Street 1:325 MCGILL AVE NW STE 524
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6239
Mailing Address - Country:US
Mailing Address - Phone:980-616-9781
Mailing Address - Fax:
Practice Address - Street 1:325 MCGILL AVE NW STE 524
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6239
Practice Address - Country:US
Practice Address - Phone:980-616-9781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care