Provider Demographics
NPI:1558728709
Name:GRACELAND HOMECARE INC.
Entity Type:Organization
Organization Name:GRACELAND HOMECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINWANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAFEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-687-7336
Mailing Address - Street 1:17 MILLER FARMS DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2768 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3239
Practice Address - Country:US
Practice Address - Phone:718-552-2694
Practice Address - Fax:718-552-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health