Provider Demographics
NPI:1386252955
Name:GRACEFUL LIVING HOME AND HEALTH LLC
Entity type:Organization
Organization Name:GRACEFUL LIVING HOME AND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TORISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:281-381-4779
Mailing Address - Street 1:11726 FORTUNE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-2530
Mailing Address - Country:US
Mailing Address - Phone:281-381-4779
Mailing Address - Fax:
Practice Address - Street 1:11726 FORTUNE PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-2530
Practice Address - Country:US
Practice Address - Phone:281-381-4779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health