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General NPI Number Information
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NPI Number | 1952265936
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Entity Type | Organization
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Legal Business Name | GRACEFUL LIFE HOMES LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1536 ANDERSON ST
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City | GASTONIA
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State | NC
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Zip | 28054-1223
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Country | US
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Telephone | 917-341-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 15135 ALIJON CT
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City | CHARLOTTE
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State | NC
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Zip | 28278-6885
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Country | US
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Telephone | 917-341-3659
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANETTE RODRIGUEZ
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Credential |
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Telephone | 917-341-3659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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