Provider Demographics
NPI:1992459036
Name:GRACEFULLEE DRIVEN HOME CARE LLC
Entity type:Organization
Organization Name:GRACEFULLEE DRIVEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANITY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-358-3110
Mailing Address - Street 1:2555 E 55TH PLACE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220
Mailing Address - Country:US
Mailing Address - Phone:317-358-3110
Mailing Address - Fax:317-754-0947
Practice Address - Street 1:2555 E 55TH PLACE
Practice Address - Street 2:SUITE 209
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220
Practice Address - Country:US
Practice Address - Phone:317-358-3110
Practice Address - Fax:317-754-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care