Organization
GRACIOUS AGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOCELYN CARLOS BSN RN (ADMINISTRATOR)
(407) 323-9914
Entity
Organization
Contact information
Practice address
1401 S MAGNOLIA AVE, SANFORD, FL 32771-3400
(407) 323-9914
(407) 323-6310
Mailing address
1401 S MAGNOLIA AVE, SANFORD, FL 32771-3400
(407) 323-9914
(407) 323-6310
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10274
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142508100
—
FL
05
—
689602200
—
FL
Enumeration date
05/29/2007
Last updated
11/04/2008
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