Provider Demographics
NPI:1225905623
Name:GRACEFUL LIVING II
Entity type:Organization
Organization Name:GRACEFUL LIVING II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-398-5059
Mailing Address - Street 1:4014 W BUIST AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-1253
Mailing Address - Country:US
Mailing Address - Phone:623-398-5059
Mailing Address - Fax:480-393-7774
Practice Address - Street 1:13205 S 38TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-8201
Practice Address - Country:US
Practice Address - Phone:623-398-5059
Practice Address - Fax:480-393-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility