Healthcare Provider Details

I. General information

NPI: 1376759209
Provider Name (Legal Business Name): LADY OF GRACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10351 BALBOA BLVD
GRANADA HILLS CA
91344-7318
US

IV. Provider business mailing address

10351 BALBOA BLVD
GRANADA HILLS CA
91344-7318
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-6651
  • Fax: 818-831-9822
Mailing address:
  • Phone: 818-831-6651
  • Fax: 818-831-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MISS ELIZABETH TUMARU PAJE
Title or Position: PRESIDENT
Credential:
Phone: 818-831-6651