Provider Demographics
NPI:1558919613
Name:GRACEFUL CAME IN HOME LLC
Entity Type:Organization
Organization Name:GRACEFUL CAME IN HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-853-9312
Mailing Address - Street 1:600 CAPITOL BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-4056
Mailing Address - Country:US
Mailing Address - Phone:574-524-6573
Mailing Address - Fax:314-338-4911
Practice Address - Street 1:600 CAPITOL BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4056
Practice Address - Country:US
Practice Address - Phone:574-524-6573
Practice Address - Fax:314-338-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health