Healthcare Provider Details

I. General information

NPI: 1932379351
Provider Name (Legal Business Name): GRACEFUL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FRIENDLY LN 6600 EAST 11TH AVE
ANCHORAGE AK
99504-2024
US

IV. Provider business mailing address

6300 E 9TH AVE 1100 FRIENDLY LANE
ANCHORAGE AK
99504-1720
US

V. Phone/Fax

Practice location:
  • Phone: 907-338-0444
  • Fax: 907-338-5768
Mailing address:
  • Phone: 907-338-3135
  • Fax: 907-338-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number34390000X
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number3446OOOOX TAXI
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number385HR0000X
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number385HR2060
License Number StateAK

VIII. Authorized Official

Name: CHRISTIANA ILOSEN ULOFOSHIO
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-338-3135