Healthcare Provider Details

I. General information

NPI: 1104708270
Provider Name (Legal Business Name): GRACEFUL LIVING HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/29/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REGUS 7733 FORSYTH BLVD, 11TH FLOOR
ST. LOUIS MO
63105
US

IV. Provider business mailing address

4037 MCDONALD AVE
SAINT LOUIS MO
63116-3818
US

V. Phone/Fax

Practice location:
  • Phone: 314-296-6000
  • Fax:
Mailing address:
  • Phone: 636-219-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA ORR
Title or Position: OWNER
Credential:
Phone: 636-219-7613