Provider Demographics
NPI:1952907065
Name:GRACELAND HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:GRACELAND HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AJIBIKE
Authorized Official - Middle Name:OLUWATOSIN
Authorized Official - Last Name:CHIKE
Authorized Official - Suffix:
Authorized Official - Credentials:CRC
Authorized Official - Phone:202-596-9536
Mailing Address - Street 1:1231 GOOD HOPE RD SE UNIT 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6907
Mailing Address - Country:US
Mailing Address - Phone:202-596-9536
Mailing Address - Fax:
Practice Address - Street 1:1231 GOOD HOPE RD SE UNIT 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6907
Practice Address - Country:US
Practice Address - Phone:202-596-9536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care