MEDICARE: GRACEFUL LIVING CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1013869767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL LIVING CARE LLC

Provider Business Mailing Address
First Line	:	3094 W MARKET ST STE 207
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3094 W MARKET ST STE 207
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3624
Country	:	US
Telephone Number	:	330-203-5681
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LANIKA TRAVIS
Credential	:
Telephone Number	:	330-203-5681

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	04/13/2026

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