Provider Demographics
NPI:1093339665
Name:GRACEFUL HEARTS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:GRACEFUL HEARTS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGIBIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-558-4725
Mailing Address - Street 1:2864 S JEBEL WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-9006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6780 E LAKE CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4410
Practice Address - Country:US
Practice Address - Phone:720-242-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility