Healthcare Provider Details

I. General information

NPI: 1457239485
Provider Name (Legal Business Name): HEART GRACE CARES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAWRENCE DR STE 470
THOUSAND OAKS CA
91320-1343
US

IV. Provider business mailing address

1200 LAWRENCE DR STE 470
THOUSAND OAKS CA
91320-1343
US

V. Phone/Fax

Practice location:
  • Phone: 805-427-4855
  • Fax:
Mailing address:
  • Phone: 805-427-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAUN EDISON BRUCE
Title or Position: TREASURER/ CFO
Credential:
Phone: 805-312-3632