Provider Demographics
NPI:1720494578
Name:A GRACEFUL WAY, LLC
Entity Type:Organization
Organization Name:A GRACEFUL WAY, LLC
Other - Org Name:A GRACEFUL WAY IN-HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SULLIVAN
Authorized Official - Last Name:REEDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-857-9644
Mailing Address - Street 1:6307 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4257
Mailing Address - Country:US
Mailing Address - Phone:310-857-9644
Mailing Address - Fax:323-753-6645
Practice Address - Street 1:6307 5TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4257
Practice Address - Country:US
Practice Address - Phone:310-857-9644
Practice Address - Fax:323-753-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201317810050253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care