Provider Demographics
NPI:1932379351
Name:GRACEFUL LIVING LLC
Entity Type:Organization
Organization Name:GRACEFUL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:ILOSEN
Authorized Official - Last Name:ULOFOSHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-338-3135
Mailing Address - Street 1:6300 E 9TH AVE
Mailing Address - Street 2:1100 FRIENDLY LANE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1720
Mailing Address - Country:US
Mailing Address - Phone:907-338-3135
Mailing Address - Fax:907-338-3012
Practice Address - Street 1:1100 FRIENDLY LN
Practice Address - Street 2:6600 EAST 11TH AVE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2024
Practice Address - Country:US
Practice Address - Phone:907-338-0444
Practice Address - Fax:907-338-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34390000X343900000X
AK3446OOOOX TAXI344600000X
AK385HR0000X385H00000X
AK385HR2060385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1548461445Medicaid
AKHC3704Medicaid