Healthcare Provider Details

I. General information

NPI: 1013869767
Provider Name (Legal Business Name): GRACEFUL LIVING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 W MARKET ST STE 207
FAIRLAWN OH
44333-3624
US

IV. Provider business mailing address

3094 W MARKET ST STE 207
FAIRLAWN OH
44333-3624
US

V. Phone/Fax

Practice location:
  • Phone: 330-203-5681
  • Fax:
Mailing address:
  • Phone:
  • 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: LANIKA TRAVIS
Title or Position: CEO
Credential:
Phone: 330-203-5681