Healthcare Provider Details

I. General information

NPI: 1003748815
Provider Name (Legal Business Name): GRACEFUL LIVING SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NW 165TH STREET RD STE 305A
MIAMI FL
33169-6342
US

IV. Provider business mailing address

540 NW 165TH STREET RD STE 305A
MIAMI FL
33169-6342
US

V. Phone/Fax

Practice location:
  • Phone: 786-818-4574
  • Fax: 786-818-4574
Mailing address:
  • Phone: 786-818-4574
  • Fax: 786-818-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ROSAIRE CANTAVE OLIVIER
Title or Position: PRESIDENT
Credential:
Phone: 786-818-4574