Healthcare Provider Details

I. General information

NPI: 1609736875
Provider Name (Legal Business Name): GRACE AT HOME PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W. OCEAN BLVD FLOOR 4, ROOM 450
LONG BEACH CA
90802
US

IV. Provider business mailing address

564 NIAGARA ST BLDG 2
BUFFALO NY
14201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 844-401-4663
  • Fax:
Mailing address:
  • Phone: 716-882-0366
  • Fax: 716-306-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RODNEY ARMSTEAD
Title or Position: CEO
Credential: MD
Phone: 716-361-0591