Healthcare Provider Details

I. General information

NPI: 1649196684
Provider Name (Legal Business Name): GRAYSON HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 LARCH ST APT A
INGLEWOOD CA
90301-0968
US

IV. Provider business mailing address

4859 W SLAUSON AVE STE 170
LOS ANGELES CA
90056-1290
US

V. Phone/Fax

Practice location:
  • Phone: 310-293-3957
  • Fax:
Mailing address:
  • Phone: 310-293-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: AZIZA KING
Title or Position: PRESIDENT
Credential:
Phone: 310-293-3957