Provider Demographics
NPI:1144829888
Name:GRAFFREAID, RODSELINE ANN (CERTIFIED CAREGIVER)
Entity type:Individual
Prefix:
First Name:RODSELINE
Middle Name:ANN
Last Name:GRAFFREAID
Suffix:
Gender:F
Credentials:CERTIFIED CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E FAIRFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3688
Mailing Address - Country:US
Mailing Address - Phone:864-520-2288
Mailing Address - Fax:
Practice Address - Street 1:716 E FAIRFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3688
Practice Address - Country:US
Practice Address - Phone:864-520-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1303372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion