MEDICARE: GRACE LIVING SUPPORT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	253Z00000X	In Home Supportive Care Agency
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568316909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE LIVING SUPPORT LLC

Provider Business Mailing Address
First Line	:	5801 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4427
Country	:	US
Telephone Number	:	216-855-6829
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 W 150TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-3464
Country	:	US
Telephone Number	:	216-855-6829
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARLENY SEPULVEDA
Credential	:	HOME HEALTH CERT
Telephone Number	:	216-855-6829

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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