Provider Demographics
NPI:1518757996
Name:GRACEFUL LIVING FAMILY HOME LLC
Entity type:Organization
Organization Name:GRACEFUL LIVING FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAJMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-279-7215
Mailing Address - Street 1:2541 NOTRE DAME DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-9407
Mailing Address - Country:US
Mailing Address - Phone:651-279-7215
Mailing Address - Fax:
Practice Address - Street 1:2541 NOTRE DAME DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-9407
Practice Address - Country:US
Practice Address - Phone:651-279-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health