Gracious Age LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10274 Issued in FL

Legal business name

GRACIOUS AGE LLC

Practice address

1401 S Magnolia Ave
Sanford, FL 32771-3400

Phone

(407) 323-9914

Fax

(407) 323-6310

NPI assigned

May 29, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Jocelyn Carlos, BSN RN

Title

Administrator

Phone

(407) 323-9914

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225756800000",
    "number": "1669673521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S MAGNOLIA AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327713400",
            "telephone_number": "407-323-9914",
            "fax_number": "407-323-6310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S MAGNOLIA AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327713400",
            "telephone_number": "407-323-9914",
            "fax_number": "407-323-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACIOUS AGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2008-11-04",
        "status": "A",
        "authorized_official_last_name": "CARLOS",
        "authorized_official_first_name": "JOCELYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-323-9914",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BSN RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL10274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "689602200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142508100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Rae Goss, REGISTERED INTERN
• Maneesh Gossain, MD
• Chelsea Lynn Govea, ARNP
• Melissa Governale
• Grace Counseling Center
• Gracious Place, LLC
• Kevin Michelle Graf-Dixon, LM
• Cara Joy Lozano Granada, DPT
• Zealene Grant
• Lauren Marie Gravois, NP-C

• Assisted Living Facility in Sanford, FL
• Providers in Sanford, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; 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.