Healthcare Provider Details

I. General information

NPI: 1134084403
Provider Name (Legal Business Name): GRACIOUS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12515 HUDSON RIVER DR
EASTVALE CA
91752-4327
US

IV. Provider business mailing address

12515 HUDSON RIVER DR
EASTVALE CA
91752-4327
US

V. Phone/Fax

Practice location:
  • Phone: 909-994-6204
  • Fax:
Mailing address:
  • Phone: 909-994-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NA ZHAO
Title or Position: MANAGER
Credential:
Phone: 909-994-6204