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General NPI Number Information
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NPI Number | 1255665303
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Entity Type | Organization
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Legal Business Name | GRACEFUL LIVING LLC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 24500 CENTER RIDGE RD STE 140
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City | WESTLAKE
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State | OH
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Zip | 44145-5621
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Country | US
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Telephone | 440-899-2617
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Fax | 440-899-2918
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Provider Business Mailing Address
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Address Line | 25200 CENTER RIDGE RD STE 140
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City | WESTLAKE
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State | OH
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Zip | 44145-4141
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Country | US
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Telephone | 440-899-2617
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Fax | 440-899-2918
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIEGO HERNANDEZ
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Credential |
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Telephone | 440-899-2617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 18-807-5
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License Number State | OH
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