Provider Demographics
NPI:1467280412
Name:GRACIOUS ANGELIC CARE LLC
Entity type:Organization
Organization Name:GRACIOUS ANGELIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:AMO
Authorized Official - Last Name:AMO DAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-308-3057
Mailing Address - Street 1:3411 KESWICK CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4860
Mailing Address - Country:US
Mailing Address - Phone:608-497-0911
Mailing Address - Fax:
Practice Address - Street 1:3411 KESWICK CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4860
Practice Address - Country:US
Practice Address - Phone:608-308-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care