Healthcare Provider Details

I. General information

NPI: 1497679195
Provider Name (Legal Business Name): GRACEFUL LIVING ALF AND MEMORY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BEVILLE RD
DAYTONA BEACH FL
32114-5924
US

IV. Provider business mailing address

700 BEVILLE RD
DAYTONA BEACH FL
32114-5924
US

V. Phone/Fax

Practice location:
  • Phone: 389-333-9699
  • Fax: 389-333-9697
Mailing address:
  • Phone: 389-333-9699
  • Fax: 389-333-9697

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: FANFAN SALIBA
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-948-2434