Provider Demographics
NPI:1699537993
Name:GRACIOUS CARE AGENCY
Entity type:Organization
Organization Name:GRACIOUS CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESI
Authorized Official - Middle Name:AFOA
Authorized Official - Last Name:BANSAH NYANKAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-435-7132
Mailing Address - Street 1:5 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7298
Mailing Address - Country:US
Mailing Address - Phone:571-435-7132
Mailing Address - Fax:
Practice Address - Street 1:5 FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7298
Practice Address - Country:US
Practice Address - Phone:571-435-7132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities