NPIMap

Organization Active NPI

Graceful Aging Home Care Inc.

  • In Home Supportive Care Agency
  • Virginia Beach, VA
National Provider Identifier
1053795732
Registry record updated Jul 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
HCO-151016 Issued in VA
Legal business name
GRACEFUL AGING HOME CARE INC.
Doing business as
Age Advantage Senior Care Services
Practice address
228 N Lynnhaven Rd
Suite 106
Virginia Beach, VA 23452-7514
Phone
(757) 340-3315
Fax
(757) 340-3317
NPI assigned
Jul 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2015

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

Authorized official

Name
Vincent R. Medina
Title
President
Phone
(757) 340-3315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X HCO-151016 VA Primary

Addresses

Primary practice location

228 N Lynnhaven Rd
Suite 106
Virginia Beach, VA 23452-7514

Mailing address

228 N Lynnhaven Rd
Suite 106
Virginia Beach, VA 23452-7514
Phone (757) 340-3315

Other identifiers 2

IdentifierTypeStateIssuer
0171722397OtherVAMEDICAID API NUMBER FOR PERSONAL CARE
0171721910OtherVAMEDICAID API NUMBER FOR RESPITE CARE

Other names 1

  • Age Advantage Senior Care Services Doing business as

National Provider Directory

National Provider Directory

Locations

228 N Lynnhaven Rd
Ste 106
Virginia Beach, VA 23452
Phone (757) 340-3315

NPI Registry JSON

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1053795732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 N LYNNHAVEN RD",
            "address_2": "SUITE 106",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527514",
            "telephone_number": "757-340-3315",
            "fax_number": "757-340-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 N LYNNHAVEN RD",
            "address_2": "SUITE 106",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527514",
            "telephone_number": "757-340-3315",
            "fax_number": "757-340-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEFUL AGING HOME CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-340-3315"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "VA",
            "license": "HCO-151016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID API NUMBER FOR PERSONAL CARE",
            "identifier": "0171722397",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID API NUMBER FOR RESPITE CARE",
            "identifier": "0171721910",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Age Advantage Senior Care Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; 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.