Provider Demographics
NPI:1124847579
Name:GRACEFUL COMPANION HOME CARE LLC
Entity type:Organization
Organization Name:GRACEFUL COMPANION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:DEVANTE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-229-9364
Mailing Address - Street 1:411 MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4016
Mailing Address - Country:US
Mailing Address - Phone:843-401-0141
Mailing Address - Fax:843-401-0141
Practice Address - Street 1:411 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4016
Practice Address - Country:US
Practice Address - Phone:843-401-0141
Practice Address - Fax:843-401-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty