Provider Demographics
NPI:1568210144
Name:GRATEFUL AND BEYOND ASSISTED LIVING LLC
Entity type:Organization
Organization Name:GRATEFUL AND BEYOND ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGWANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-445-0567
Mailing Address - Street 1:18744 W SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0019
Mailing Address - Country:US
Mailing Address - Phone:480-590-2255
Mailing Address - Fax:
Practice Address - Street 1:18744 W SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-0019
Practice Address - Country:US
Practice Address - Phone:480-590-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility