MEDICARE: GRACELIGHT COMMUNITY HEALTH

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	261QF0400X	Federally Qualified Health Center (FQHC)	960000926	CA

General Provider Information

NPI Number	:	1639241888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACELIGHT COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	4816 E 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1602
Country	:	US
Telephone Number	:	323-780-4510
Fax Number	:	323-780-6132

Provider Business Practice Location Address
First Line	:	5000 W SUNSET BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5865
Country	:	US
Telephone Number	:	323-953-7170
Fax Number	:	323-663-2379

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MARINA SNITMAN
Credential	:
Telephone Number	:	323-635-1153

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	04/23/2026

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Directions to “GRACELIGHT COMMUNITY HEALTH ” Practice Location

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