MEDICARE: GRACE HAVEN LIVING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	324500000X	Substance Abuse Rehabilitation Facility
3	343900000X	Non-emergency Medical Transport (VAN)
4	364SC1501X	Community Health/Public Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1992656219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HAVEN LIVING LLC

Provider Business Mailing Address
First Line	:	1437 E 86TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1015
Country	:	US
Telephone Number	:	216-616-7846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 E 86TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1015
Country	:	US
Telephone Number	:	216-616-7846
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANTE LYDELL WILLIAMS
Credential	:
Telephone Number	:	216-616-7846

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

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Directions to “GRACE HAVEN LIVING LLC ” Practice Location

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