Provider Demographics
NPI:1689390809
Name:GRACIOUS GROUP CARE AGENCY,LLC
Entity Type:Organization
Organization Name:GRACIOUS GROUP CARE AGENCY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-444-0493
Mailing Address - Street 1:2 MEADOW SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1005
Mailing Address - Country:US
Mailing Address - Phone:864-444-0493
Mailing Address - Fax:864-450-9060
Practice Address - Street 1:449 W CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2767
Practice Address - Country:US
Practice Address - Phone:864-444-0493
Practice Address - Fax:864-450-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care