Provider Demographics
NPI:1891571899
Name:GRACIE HOMECARE LLC
Entity Type:Organization
Organization Name:GRACIE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOSIN
Authorized Official - Middle Name:JUMOKE
Authorized Official - Last Name:ADESINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-309-4660
Mailing Address - Street 1:2745 SUDBURY TRCE
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2745 SUDBURY TRCE
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2768
Practice Address - Country:US
Practice Address - Phone:770-309-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care