Healthcare Provider Details

I. General information

NPI: 1568316909
Provider Name (Legal Business Name): GRACE LIVING SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W 150TH ST
CLEVELAND OH
44135-3464
US

IV. Provider business mailing address

5801 CLARK AVE
CLEVELAND OH
44102-4427
US

V. Phone/Fax

Practice location:
  • Phone: 216-855-6829
  • Fax:
Mailing address:
  • Phone: 216-855-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARLENY SEPULVEDA
Title or Position: OWNER
Credential: HOME HEALTH CERT
Phone: 216-855-6829