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General NPI Number Information
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NPI Number | 1215747274
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Entity Type | Organization
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Legal Business Name | AGING WITH GRACE HOUSING INITIATIVE
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 6464 VILLA DR
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City | SACRAMENTO
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State | CA
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Zip | 95842-2426
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Country | US
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Telephone | 415-385-9523
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 WEBSTER ST APT 14
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-3400
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Country | US
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Telephone | 415-385-9523
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDREAS MATHEW MEHALAKIS
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Credential |
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Telephone | 415-385-9523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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