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General NPI Number Information
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NPI Number | 1174750863
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Entity Type | Organization
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Legal Business Name | GRACIOUS LIVING HOMES OF CARE
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 2796 FOOTHILL RD
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City | SANTA BARBARA
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State | CA
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Zip | 93105-2902
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Country | US
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Telephone | 805-563-4502
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Fax | 805-617-3233
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Provider Business Mailing Address
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Address Line | 2796 FOOTHILL RD
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City | SANTA BARBARA
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State | CA
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Zip | 93105-2902
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Country | US
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Telephone | 805-563-4502
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Fax | 805-617-3233
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. STEVEN WALL
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Credential |
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Telephone | 805-680-4915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 425801505
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 425801498
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License Number State | CA
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