Provider Demographics
NPI:1407470057
Name:GRACEFUL ADULT FAMILY HOME LLC.
Entity Type:Organization
Organization Name:GRACEFUL ADULT FAMILY HOME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIM
Authorized Official - Middle Name:MEBRAHTU
Authorized Official - Last Name:PAULOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-294-9801
Mailing Address - Street 1:1421 S CHRONICLE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-3403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1421 S CHRONICLE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-3403
Practice Address - Country:US
Practice Address - Phone:206-294-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty