Provider Demographics
NPI:1780227884
Name:GRACEFUL LIFE CARE LLC
Entity Type:Organization
Organization Name:GRACEFUL LIFE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BONET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-772-9725
Mailing Address - Street 1:4 SKIFF ST APT B310
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1834
Mailing Address - Country:US
Mailing Address - Phone:203-772-9725
Mailing Address - Fax:203-717-5998
Practice Address - Street 1:280 QUARRY RD UNIT C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8543
Practice Address - Country:US
Practice Address - Phone:203-772-9725
Practice Address - Fax:201-717-5998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACEFUL LIFE CHURCH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-21
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251G00000XAgenciesHospice Care, Community Based
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing PersonnelGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTHCA0001489OtherHCA0001489