Provider Demographics
NPI:1679328850
Name:GRACEFUL LIVING IN HOME CARE, LLC
Entity Type:Organization
Organization Name:GRACEFUL LIVING IN HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONDE
Authorized Official - Middle Name:TYESE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-320-5313
Mailing Address - Street 1:135 E MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4892
Mailing Address - Country:US
Mailing Address - Phone:803-973-6060
Mailing Address - Fax:
Practice Address - Street 1:135 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4892
Practice Address - Country:US
Practice Address - Phone:803-973-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health