Provider Demographics
NPI:1790538395
Name:GRAYSFUL LIVING LLC
Entity Type:Organization
Organization Name:GRAYSFUL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-338-4730
Mailing Address - Street 1:4017 CALAIS CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9348
Mailing Address - Country:US
Mailing Address - Phone:209-338-4730
Mailing Address - Fax:
Practice Address - Street 1:1552 E MUNCIE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2319
Practice Address - Country:US
Practice Address - Phone:559-297-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility