Provider Demographics
NPI:1881320430
Name:GRACEFULLY MEEK HOME CARE LLC
Entity type:Organization
Organization Name:GRACEFULLY MEEK HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-215-3179
Mailing Address - Street 1:319 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-0517
Mailing Address - Country:US
Mailing Address - Phone:352-215-3179
Mailing Address - Fax:352-389-2690
Practice Address - Street 1:319 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0517
Practice Address - Country:US
Practice Address - Phone:352-215-3179
Practice Address - Fax:352-389-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115000100Medicaid
FL30212823OtherNURSE REGISTRY LICENSE NUMBER