Provider Demographics
NPI:1386476729
Name:GRACEFULLY AGING HOME CARE LLC
Entity type:Organization
Organization Name:GRACEFULLY AGING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMEKA
Authorized Official - Middle Name:TYSHEENA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-773-8193
Mailing Address - Street 1:2936 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-3542
Mailing Address - Country:US
Mailing Address - Phone:856-773-8193
Mailing Address - Fax:
Practice Address - Street 1:2936 RUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3542
Practice Address - Country:US
Practice Address - Phone:856-773-8193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health