Provider Demographics
NPI:1679272702
Name:GRACIE CARE LC
Entity Type:Organization
Organization Name:GRACIE CARE LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TATENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWENA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:202-853-8097
Mailing Address - Street 1:3205 BEAVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3001
Mailing Address - Country:US
Mailing Address - Phone:202-853-8097
Mailing Address - Fax:
Practice Address - Street 1:3205 BEAVERWOOD LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3001
Practice Address - Country:US
Practice Address - Phone:202-853-8097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care