MEDICARE: GIFT OF GRACE RESIDENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1144199688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFT OF GRACE RESIDENCE

Provider Business Mailing Address
First Line	:	611 WILSHIRE BLVD STE 900
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 W 46TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2722
Country	:	US
Telephone Number	:	323-400-9462
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KENISHA FANIEL
Credential	:
Telephone Number	:	323-400-9462

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

Similar Medicare Providers

1548192008 — SHANA EVE LUTKER LMFT
Practice Location Address:

6401 RUBY ST
LOS ANGELES, CA
90042-2722

Practice Phone: 323-488-8723
Practice Fax:

1134459126 — MS. CAROLYN M MCNITT PT
Practice Location Address:

170 N CANYON VIEW DR
LOS ANGELES, CA
90049-2722

Practice Phone: 310-740-5080
Practice Fax:

1811369945 — DR. BYRON VREELAND
Practice Location Address:

10514 HEBRON LN
LOS ANGELES, CA
90077-2722

Practice Phone: 310-474-8755
Practice Fax:

1528568169 — SH ESCALATE ENTERPRISE, INC.
Practice Location Address:

2722 S WESTERN AVE
LOS ANGELES, CA
90018-3030

Practice Phone: 323-643-4880
Practice Fax: 323-643-4838

1104540897 — PREFERRED HEALTH STAFFING SERVICES INC
Practice Location Address:

2722 S WESTERN AVE BLDG B
LOS ANGELES, CA
90018-3030

Practice Phone: 213-268-4233
Practice Fax:

1194697185 — LISA ALVARADO
Practice Location Address:

680 E 120TH ST
LOS ANGELES, CA
90059-2722

Practice Phone: 424-338-8000
Practice Fax:

Directions to “GIFT OF GRACE RESIDENCE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.