GRACIOUS AGE LLC (NPI# 1669673521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669673521 |
| Entity Type | Organization |
| Organization Name | GRACIOUS AGE LLC |
| Practice Address |
1401 S Magnolia Ave Sanford FL 32771-3400 |
| Practice Telephone | 4073239914 |
| Practice Fax Number | 4073236310 |
| Mailing Telephone | 4073239914 |
| Mailing Fax Number | 4073236310 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2008-11-04 |
| Authorized Official Name | MS. JOCELYN CARLOS (ADMINISTRATOR) |
| Authorized Official Telephone | 4073239914 |
| Authorized Official Credential | BSN RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL10274 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 142508100 | 05 | |
| FL | 689602200 | 05 |
| Street Address |
1401 S MAGNOLIA AVE |
| City | SANFORD |
| State | FL |
| Zip Code | 32771-3400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134695224 | Sheena L Grayson | Pharmacist | 4942 W State Rd 46, Suite 1014, Sanford, FL 32771 | 2018-10-16 |
| 1699284299 | Christopher Ryan King | Chiropractor | 1026 Old England Loop, Sanford, FL 32771 | 2017-09-26 |
| 1669991345 | Scarlett Sierra | Counselor | 401 W Seminole Blvd, Sanford, FL 32771 | 2017-09-14 |
| 1881132249 | Tracy Shibla | Nurse Practitioner | 2320 Retreat View Cir, Sanford, FL 32771 | 2017-02-06 |
| 1205387206 | Tabitha Boyd | Behavior Technician | 4136 Geranium Ln #102, Sanford, FL 32771 | 2016-10-14 |
| 1104275874 | Jessica Willis | Nurse Anesthetist, Certified Registered | 108 Temple Dr, Sanford, FL 32771 | 2016-06-03 |
| 1013379957 | Bai Medical LLC | Point of Service | 580 Lexington Green Lane, Sanford, FL 32771 | 2016-03-21 |
| 1710347851 | Melissa T Ramsawak | Nurse Practitioner | 4930 East Lake Mary Boulevard, Sanford, FL 32771 | 2016-03-02 |
| 1811394570 | Tanesha Burns | Counselor | 209 San Carlos Ave Ste 111a, Sanford, FL 32771 | 2014-11-24 |
| 1053717322 | Amy Hertz, Dmd and Minta Lopez-torres, Dmd | Dentist | 5030 West Sr 46, Suite 1018, Sanford, FL 32771 | 2014-11-13 |
| Find all providers in zip 32771 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871009258 | Sunshine Pharmacy of Sanford LLC | Assisted Living Facility | 5040 Sr 46 Ste 1126, Sanford, FL 32771-9252 | 2017-12-20 |
| 1790186526 | Parkview Retirement Center, Inc. | Assisted Living Facility | 1801 Wicker St, Sanford, NC 27330-7782 | 2014-09-11 |
| 1720418635 | Hope Assisted Living Facility | Assisted Living Facility | 1401 Dixie Way, Sanford, FL 32771-3034 | 2013-11-14 |
| 1548604267 | Nic 5 Renaissance Retirement Leasing LLC | Assisted Living Facility | 300 W Airport Blvd., Sanford, FL 32773 | 2013-04-24 |
| 1104060656 | Manor At Phillipstown Place Inc | Assisted Living Facility | 27 Mayflower St, Sanford, ME 04073-3645 | 2009-04-28 |
| 1538324801 | Renassaince Retirement Center, LLC | Assisted Living Facility | 300 W Airport Blvd, Sanford, FL 32773-8000 | 2008-07-25 |
| 1992988547 | Guardian Home Alf LLC | Assisted Living Facility | 431 E Airport Blvd, Sanford, FL 32773-5494 | 2007-12-06 |
| 1629258678 | Alternative Senior Care | Assisted Living Facility | 5433 Sr 46, Sanford, FL 32771-9236 | 2007-11-07 |
| 1316133374 | Leak's Family Care Home | Assisted Living Facility | 302 Stone St, Sanford, NC 27330-5831 | 2007-09-24 |
| 1043406002 | Leak's Family Care Home | Assisted Living Facility | 548 Cox Maddox Rd, Sanford, NC 27332-8019 | 2007-09-24 |
| Find all providers in SANFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.