Provider Demographics
NPI:1790141281
Name:GRACIOUS HAVEN HEALTHCARE LLC
Entity Type:Organization
Organization Name:GRACIOUS HAVEN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-975-3119
Mailing Address - Street 1:PO BOX 64636
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4636
Mailing Address - Country:US
Mailing Address - Phone:520-975-3119
Mailing Address - Fax:520-844-1522
Practice Address - Street 1:3843 E PRESIDIO RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1736
Practice Address - Country:US
Practice Address - Phone:520-975-3119
Practice Address - Fax:520-844-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care