Provider Demographics
NPI:1497579536
Name:GRACEFUL LIVING ASSISTED LIVING LLC
Entity type:Organization
Organization Name:GRACEFUL LIVING ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KUBURAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GANIYU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-669-8746
Mailing Address - Street 1:624 JONES FERRY ROAD
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510
Mailing Address - Country:US
Mailing Address - Phone:919-933-9570
Mailing Address - Fax:919-933-9572
Practice Address - Street 1:624 JONES FERRY RD
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2157
Practice Address - Country:US
Practice Address - Phone:919-933-9570
Practice Address - Fax:919-933-9572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility