Healthcare Provider Details

I. General information

NPI: 1033426028
Provider Name (Legal Business Name): GRACE FAMILY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2010
Last Update Date: 01/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24910 LAS BRISAS RD SUITE 105
MURRIETA CA
92562-4010
US

IV. Provider business mailing address

23811 WASHINGTON AVE C110-220
MURRIETA CA
92562-2267
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-1385
  • Fax: 951-461-9191
Mailing address:
  • Phone: 951-231-1385
  • Fax: 866-686-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA066038
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA066038
License Number StateCA

VIII. Authorized Official

Name: DR. LILY YUNG PHILLIPS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-231-1385