Provider Demographics
NPI:1982025524
Name:GRACEFUL HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:GRACEFUL HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-744-1804
Mailing Address - Street 1:2082 NEWBURY RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3329
Mailing Address - Country:US
Mailing Address - Phone:805-498-9488
Mailing Address - Fax:805-262-6243
Practice Address - Street 1:2082 NEWBURY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3329
Practice Address - Country:US
Practice Address - Phone:805-498-9488
Practice Address - Fax:805-262-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health