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General NPI Number Information
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NPI Number | 1548461445
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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 | 05/29/2007
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 6600 E 11TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99504-1734
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Country | US
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Telephone | 907-338-3135
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 E 11TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99504-1734
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Country | US
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Telephone | 907-338-3135
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Fax |
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Authorized Official
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Title or Position | ADMINISTATOR
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Name | CHRISTIANA IIOSEN ULOFOSHIO
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Credential | CARE PROVIDER
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Telephone | 907-952-9918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 000299
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License Number State | AK
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