Healthcare Provider Details

I. General information

NPI: 1801716261
Provider Name (Legal Business Name): GRACEFUL LIVING HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 SUNRISE BLVD E APT J206
PUYALLUP WA
98374-8018
US

IV. Provider business mailing address

12020 SUNRISE BLVD E APT J206
PUYALLUP WA
98374-8018
US

V. Phone/Fax

Practice location:
  • Phone: 405-318-1779
  • Fax:
Mailing address:
  • Phone: 405-318-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLOVIS AKAM NGWA
Title or Position: OWNER
Credential: CNA
Phone: 405-318-1779