Healthcare Provider Details

I. General information

NPI: 1669213088
Provider Name (Legal Business Name): PICCS WITH GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 SWINGSTONE DR
HEMET CA
92545-6125
US

IV. Provider business mailing address

5450 SWINGSTONE DR
HEMET CA
92545-6125
US

V. Phone/Fax

Practice location:
  • Phone: 678-634-9040
  • Fax:
Mailing address:
  • Phone: 678-634-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRACE HILLARD
Title or Position: NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 678-634-9040