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General NPI Number Information
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NPI Number | 1093073983
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Entity Type | Organization
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Legal Business Name | GRACIOUS LIFE, LLC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1500 DETROIT AVE 319
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City | CLEVELAND
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State | OH
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Zip | 44113-2444
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Country | US
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Telephone | 216-894-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 DETROIT AVE 319
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City | CLEVELAND
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State | OH
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Zip | 44113-2444
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SILVIA DONOFRIO
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Credential |
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Telephone | 216-894-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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