Organization
GRACEFUL AGING HOME CARE INC.
Active
Other names
Age Advantage Senior Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT R. MEDINA (PRESIDENT)
(757) 340-3315
Entity
Organization
Contact information
Practice address
228 N LYNNHAVEN RD, SUITE 106, VIRGINIA BEACH, VA 23452-7514
(757) 340-3315
(757) 340-3317
Mailing address
228 N LYNNHAVEN RD, SUITE 106, VIRGINIA BEACH, VA 23452-7514
(757) 340-3315
(757) 340-3317
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HCO-151016
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0171721910
MEDICAID API NUMBER FOR RESPITE CARE
VA
01
—
0171722397
MEDICAID API NUMBER FOR PERSONAL CARE
VA
Enumeration date
07/13/2015
Last updated
07/13/2015
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