Healthcare Provider Details

I. General information

NPI: 1801711932
Provider Name (Legal Business Name): GRACEFUL HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 SAINT CLAIR AVE E
NORTH FORT MYERS FL
33903-4649
US

IV. Provider business mailing address

14359 MIRAMAR PKWY # 245
MIRAMAR FL
33027-4134
US

V. Phone/Fax

Practice location:
  • Phone: 305-763-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PENNINAH MUKIRI
Title or Position: OWNER
Credential:
Phone: 305-763-1188