Healthcare Provider Details

I. General information

NPI: 1235047556
Provider Name (Legal Business Name): CHIANTI GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9063 CHIANTI CIR
STOCKTON CA
95212-3816
US

IV. Provider business mailing address

9063 CHIANTI CIR
STOCKTON CA
95212-3816
US

V. Phone/Fax

Practice location:
  • Phone: 209-451-4528
  • Fax: 888-927-7518
Mailing address:
  • Phone: 209-451-4528
  • Fax: 888-927-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARICAR MORELOS LAUREL
Title or Position: LICENSEE / OWNER
Credential:
Phone: 209-688-8058