MEDICARE: GRACEFUL LIVING HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1194664573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL LIVING HOME CARE LLC

Provider Business Mailing Address
First Line	:	116 AGNES RD STE 200
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-6306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 AGNES RD STE 200
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-6306
Country	:	US
Telephone Number	:	865-247-1450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FANTA SANOE
Credential	:
Telephone Number	:	865-247-1450

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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