Provider Demographics
NPI:1760221923
Name:GRACEFULLY AGING LLC
Entity type:Organization
Organization Name:GRACEFULLY AGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHAWNA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-808-9667
Mailing Address - Street 1:214 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-3101
Mailing Address - Country:US
Mailing Address - Phone:256-808-9667
Mailing Address - Fax:256-813-5193
Practice Address - Street 1:14267 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-9475
Practice Address - Country:US
Practice Address - Phone:256-808-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251K00000XAgenciesPublic Health or Welfare
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)