Provider Demographics
NPI:1871145441
Name:GRACEFUL CARE HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:GRACEFUL CARE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:CLAUNA
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-758-9349
Mailing Address - Street 1:2082 NEWBURY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3352
Mailing Address - Country:US
Mailing Address - Phone:805-758-9339
Mailing Address - Fax:805-309-5188
Practice Address - Street 1:2082 NEWBURY RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3352
Practice Address - Country:US
Practice Address - Phone:805-758-9339
Practice Address - Fax:805-309-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health