Healthcare Provider Details

I. General information

NPI: 1811793235
Provider Name (Legal Business Name): GRACEFUL CARGIVERS SOLUTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 HARVEST AVE
LIBERTY TWP OH
45011-2368
US

IV. Provider business mailing address

4641 HARVEST AVE
LIBERTY TWP OH
45011-2368
US

V. Phone/Fax

Practice location:
  • Phone: 773-387-6476
  • Fax:
Mailing address:
  • Phone: 773-387-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARINE NTSONONG AYAFOR
Title or Position: DODD
Credential: DO
Phone: 773-387-6476