Provider Demographics
NPI:1336904473
Name:GRACEFUL DAY PERSONAL HOME CARE
Entity Type:Organization
Organization Name:GRACEFUL DAY PERSONAL HOME CARE
Other - Org Name:GRACEFUL DAY PERSONAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:BRANDA
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-494-3146
Mailing Address - Street 1:824 S FALCON ST APT C
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4568
Mailing Address - Country:US
Mailing Address - Phone:954-494-3146
Mailing Address - Fax:
Practice Address - Street 1:824 S FALCON ST APT C
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4568
Practice Address - Country:US
Practice Address - Phone:954-494-3146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty