Healthcare Provider Details

I. General information

NPI: 1861327587
Provider Name (Legal Business Name): ELDER GRACE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23102 E SADDLE WAY
QUEEN CREEK AZ
85142-0728
US

IV. Provider business mailing address

23102 E SADDLE WAY
QUEEN CREEK AZ
85142-0728
US

V. Phone/Fax

Practice location:
  • Phone: 480-434-0240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: GAURAV KHANAL
Title or Position: OWNER
Credential:
Phone: 480-434-0240