Healthcare Provider Details

I. General information

NPI: 1841010410
Provider Name (Legal Business Name): GRACEFUL LIVING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 SILVER LAKE RD NW
SAINT PAUL MN
55112-6319
US

IV. Provider business mailing address

1435 SILVER LAKE RD NW
SAINT PAUL MN
55112-6319
US

V. Phone/Fax

Practice location:
  • Phone: 612-685-2994
  • Fax:
Mailing address:
  • Phone: 612-685-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SHARMARKE M ABDILAHI
Title or Position: CEO
Credential:
Phone: 612-685-2994