Graceful Lodge, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

GRACEFUL LODGE, LLC

Practice address

6430 June Ave N
Brooklyn Center, MN 55429-2127

Phone

(763) 496-9056

NPI assigned

Dec 13, 2019

Organization subpart

No

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

Authorized official

Name

Daniel S. BrewerNPI 1083257760

Title

Administrator

Phone

(763) 496-9056

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GRACEFUL LODGE HOME CARE Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel S. Brewer Jr.

  • Home Health Aide
  • Brooklyn Center, MN
  • NPI 1083257760
  NPD Authorized official

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576368000000",
    "number": "1629616289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 COUNTY ROAD 10 STE 320F",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293072",
            "telephone_number": "763-496-9056",
            "fax_number": "763-374-3882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6430 JUNE AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554292127",
            "telephone_number": "763-496-9056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEFUL LODGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-13",
        "last_updated": "2019-12-15",
        "certification_date": "2019-12-15",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "763-496-9056"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPREHENSIVE LICENSED HOME CARE SERVICE",
            "identifier": "394111",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRACEFUL LODGE HOME CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Goodness Ans Mercy Health Services, Incorporated
• Goshen Health Services LLC
• Adrianne Jannibah Gould, COMMUNITY HEALTH
• Grace at Home Care LLC
• Graceful Aging Health Care Inc
• Graceland Homes
• Brenda Graham
• Marion Graham
• Joseph John Grahek, C.M.T
• Jamie Granlund

• Home Health Agency in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2019; 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.