Provider Demographics
NPI:1700014727
Name:GRACEFUL LIVING LLC
Entity Type:Organization
Organization Name:GRACEFUL LIVING LLC
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:ILUSEN
Authorized Official - Last Name:ULOFOSHIO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-929-2431
Mailing Address - Street 1:6300 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1720
Mailing Address - Country:US
Mailing Address - Phone:907-929-2431
Mailing Address - Fax:907-338-3012
Practice Address - Street 1:6300 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1720
Practice Address - Country:US
Practice Address - Phone:907-929-2431
Practice Address - Fax:907-338-3012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACEFUL LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1548461445Medicaid