Provider Demographics
NPI:1104709336
Name:GRACEFUL LIVING LLC
Entity type:Organization
Organization Name:GRACEFUL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAFSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-469-6590
Mailing Address - Street 1:315 COURTLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 COURTLEIGH ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1713
Practice Address - Country:US
Practice Address - Phone:316-469-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility