Provider Demographics
NPI:1144738576
Name:GRACEFUL LIVING CENTER INC.
Entity Type:Organization
Organization Name:GRACEFUL LIVING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARDELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-442-5740
Mailing Address - Street 1:PO BOX 16944
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-0944
Mailing Address - Country:US
Mailing Address - Phone:414-442-5740
Mailing Address - Fax:414-442-4655
Practice Address - Street 1:3628 N 41ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3437
Practice Address - Country:US
Practice Address - Phone:414-442-5740
Practice Address - Fax:414-442-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health