Healthcare Provider Details

I. General information

NPI: 1699698456
Provider Name (Legal Business Name): GRACEFUL LIVING ADULT HOME RCFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 E MEATS AVE
ORANGE CA
92865-3864
US

IV. Provider business mailing address

990 S CALLE VENADO
ANAHEIM CA
92807-5006
US

V. Phone/Fax

Practice location:
  • Phone: 562-688-8895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DONIA ANAIM
Title or Position: LICENSEE
Credential:
Phone: 562-688-8895