Organization
GRACEFUL LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRCEA BOGDAN CONDOR (CHIEF FINANCIAL OFFICER)
(209) 595-0215
Entity
Organization
Contact information
Practice address
3709 CORRINE LN, MODESTO, CA 95356-9407
(209) 595-0215
Mailing address
3709 CORRINE LN, MODESTO, CA 95356-9407
(209) 595-0215
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LIC507003595
COMMUNITY CARE LICENSING
CA
Enumeration date
12/16/2020
Last updated
12/16/2020
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