Provider Demographics
NPI:1447483003
Name:GRACEFUL LIVING HOME CARE LLC
Entity type:Organization
Organization Name:GRACEFUL LIVING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-705-7212
Mailing Address - Street 1:6043 HUDSON RD STE 140K
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1030
Mailing Address - Country:US
Mailing Address - Phone:651-705-7212
Mailing Address - Fax:888-603-8429
Practice Address - Street 1:6043 HUDSON RD STE 140K
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1030
Practice Address - Country:US
Practice Address - Phone:651-705-7212
Practice Address - Fax:888-603-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN345982251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health