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General NPI Number Information
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NPI Number | 1083949572
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Entity Type | Organization
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Legal Business Name | A PLACE OF GRACE HOME HEALTHCARE AGENCY L.L.C.
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 6820 LATIJERA BLVD. #201
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City | LOS ANGELES
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State | CA
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Zip | 90045
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Country | US
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Telephone | 323-753-3679
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Fax |
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Provider Business Mailing Address
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Address Line | 2623 W 78TH PL
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City | INGLEWOOD
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State | CA
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Zip | 90305-1023
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Country | US
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Telephone | 323-753-3679
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. APRIL WILEY
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Credential |
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Telephone | 323-753-3679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | CA
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