Aging Grace LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12669 Issued in FL

Legal business name

AGING GRACE LLC

Practice address

2408 Soutel Dr
Jacksonville, FL 32208-5512

Phone

(904) 237-0206

NPI assigned

Jun 7, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Corey Lennard Bradford

Title

Owner

Phone

(904) 505-1572

Specialties & licenses 1

Addresses

Other names 1

• The Inn At Aging Grace Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789084800000",
    "number": "1013397850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 SOUTEL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322085512",
            "telephone_number": "904-505-1572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2408 SOUTEL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322085512",
            "telephone_number": "904-237-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGING GRACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-07",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "LENNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-505-1572"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Inn At Aging Grace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abhimanyu Aggarwal, MD
• Amin Nima Aghaebrahim, M.D.
• Shealy Aghamalian, PA-C
• Aging at Home LLC
• Aging Grace Enterprises LLC
• Danielle Rae Agnello
• Agnes Street Home for the Elderly
• Concepcion Latoza Agnila, M.D.
• Deogracias Remandaban Agnila Jr., NP-C
• Agr Multiservices Inc

• All providers in Jacksonville, FL
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.