Provider Demographics
NPI:1861104648
Name:GRACIOUS HEALTH & HUMAN SERVICES INC
Entity type:Organization
Organization Name:GRACIOUS HEALTH & HUMAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IKPECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-353-7037
Mailing Address - Street 1:PO BOX 1112
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1112
Mailing Address - Country:US
Mailing Address - Phone:404-353-7037
Mailing Address - Fax:404-239-3903
Practice Address - Street 1:223 SCENIC HWY STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5603
Practice Address - Country:US
Practice Address - Phone:404-353-7037
Practice Address - Fax:404-239-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health