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General NPI Number Information
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NPI Number | 1033008925
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Entity Type | Organization
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Legal Business Name | GRACELIGHT COMMUNITY HEALTH
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 4816 E 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90022-1602
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Country | US
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Telephone | 323-780-4510
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Fax | 323-981-1662
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Provider Business Mailing Address
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Address Line | 4816 E 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90022-1602
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Country | US
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Telephone | 323-780-4510
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Fax | 323-981-1662
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MARINA SNITMAN
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Credential |
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Telephone | 323-635-1153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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