Healthcare Provider Details

I. General information

NPI: 1437077047
Provider Name (Legal Business Name): LEAN ON GRACE CARE SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5493 STONEVIEW RD
RANCHO CUCAMONGA CA
91739-8933
US

IV. Provider business mailing address

5493 STONEVIEW RD
RANCHO CUCAMONGA CA
91739-8933
US

V. Phone/Fax

Practice location:
  • Phone: 310-946-5578
  • Fax:
Mailing address:
  • Phone: 310-946-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KEMERICK N. TAKANG
Title or Position: DIRECTOR
Credential:
Phone: 310-946-5578