Provider Demographics
NPI:1538774245
Name:GRACEFULLY AGING HEALTHCARE SERVICE LLC
Entity type:Organization
Organization Name:GRACEFULLY AGING HEALTHCARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-744-9043
Mailing Address - Street 1:1950 LEE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7210
Mailing Address - Country:US
Mailing Address - Phone:407-744-9043
Mailing Address - Fax:407-612-2183
Practice Address - Street 1:1950 LEE RD STE 204
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7210
Practice Address - Country:US
Practice Address - Phone:407-744-9043
Practice Address - Fax:407-612-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care