Healthcare Provider Details

I. General information

NPI: 1992656219
Provider Name (Legal Business Name): GRACE HAVEN LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 E 86TH ST
CLEVELAND OH
44106-1015
US

IV. Provider business mailing address

1437 E 86TH ST
CLEVELAND OH
44106-1015
US

V. Phone/Fax

Practice location:
  • Phone: 216-616-7846
  • Fax:
Mailing address:
  • Phone: 216-616-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DANTE LYDELL WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 216-616-7846