Provider Demographics
NPI:1972160687
Name:GRACEFUL HANDS HOME CARE LLC
Entity type:Organization
Organization Name:GRACEFUL HANDS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPN
Authorized Official - Prefix:
Authorized Official - First Name:CIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-938-1528
Mailing Address - Street 1:205 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3603
Mailing Address - Country:US
Mailing Address - Phone:229-942-3186
Mailing Address - Fax:
Practice Address - Street 1:205 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3603
Practice Address - Country:US
Practice Address - Phone:229-942-3186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care