Provider Demographics
NPI:1013258094
Name:GRACEFUL CARE AGENCY
Entity type:Organization
Organization Name:GRACEFUL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:N
Authorized Official - Last Name:KANBI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-777-2338
Mailing Address - Street 1:8899 BROOKSIDE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7112
Mailing Address - Country:US
Mailing Address - Phone:513-777-2338
Mailing Address - Fax:513-777-0208
Practice Address - Street 1:8899 BROOKSIDE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7112
Practice Address - Country:US
Practice Address - Phone:513-777-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084767Medicaid