MEDICARE: ELDER GRACE ASSISTED LIVING LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1861327587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDER GRACE ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	23102 E SADDLE WAY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-0728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23102 E SADDLE WAY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-0728
Country	:	US
Telephone Number	:	480-434-0240
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GAURAV KHANAL
Credential	:
Telephone Number	:	480-434-0240

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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