Healthcare Provider Details

I. General information

NPI: 1114839297
Provider Name (Legal Business Name): GRACEFUL CITIZENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 MILLBROOK CT
SCHAUMBURG IL
60193-1235
US

IV. Provider business mailing address

1431 MILLBROOK CT
SCHAUMBURG IL
60193-1235
US

V. Phone/Fax

Practice location:
  • Phone: 773-656-9766
  • Fax:
Mailing address:
  • Phone: 773-656-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EZENNA F AMADI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-656-9766