Provider Demographics
NPI:1649597790
Name:AGING GRACEFULLY, SENIOR CARE SERVICES
Entity Type:Organization
Organization Name:AGING GRACEFULLY, SENIOR CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:ROOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-873-5121
Mailing Address - Street 1:4003 LADSON RD
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4936
Mailing Address - Country:US
Mailing Address - Phone:843-873-5121
Mailing Address - Fax:843-873-5108
Practice Address - Street 1:4003 LADSON RD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4936
Practice Address - Country:US
Practice Address - Phone:843-873-5121
Practice Address - Fax:843-873-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC0249251J00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care