Organization
GRACEFUL HOME SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLE ROBERTSON (OWNER)
(863) 258-4147
Entity
Organization
Contact information
Practice address
2236 BLACKWOOD DR, MULBERRY, FL 33860-5500
(863) 258-4147
Mailing address
2236 BLACKWOOD DR, MULBERRY, FL 33860-5500
(863) 258-4147
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105551700
—
FL
Enumeration date
09/16/2021
Last updated
12/29/2021
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