Provider Demographics
NPI:1043103260
Name:GRACEFUL CARE PRIMARY SERVICES LLC
Entity type:Organization
Organization Name:GRACEFUL CARE PRIMARY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:719-233-0383
Mailing Address - Street 1:8767 ROYAL MELBOURNE CIR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4103
Mailing Address - Country:US
Mailing Address - Phone:719-233-0383
Mailing Address - Fax:
Practice Address - Street 1:7222 COMMERCE CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2631
Practice Address - Country:US
Practice Address - Phone:719-233-0383
Practice Address - Fax:719-890-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty