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General NPI Number Information
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NPI Number | 1003748815
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Entity Type | Organization
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Legal Business Name | GRACEFUL LIVING SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 540 NW 165TH STREET RD STE 305A
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City | MIAMI
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State | FL
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Zip | 33169-6342
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Country | US
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Telephone | 786-818-4574
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Fax | 786-818-4574
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Provider Business Mailing Address
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Address Line | 540 NW 165TH STREET RD STE 305A
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City | MIAMI
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State | FL
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Zip | 33169-6342
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Country | US
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Telephone | 786-818-4574
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Fax | 786-818-4574
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSAIRE CANTAVE OLIVIER
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Credential |
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Telephone | 786-818-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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