Provider Demographics
NPI:1780948380
Name:GRACEFUL AGING HEALTH CARE INC
Entity type:Organization
Organization Name:GRACEFUL AGING HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAM SECKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-307-9252
Mailing Address - Street 1:5701 SHINGLE CREEK PKWY STE 250E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2335
Mailing Address - Country:US
Mailing Address - Phone:763-307-9252
Mailing Address - Fax:763-575-8845
Practice Address - Street 1:5701 SHINGLE CREEK PKWY STE 250E
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2335
Practice Address - Country:US
Practice Address - Phone:763-307-9252
Practice Address - Fax:763-575-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN357756251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health