=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326032137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 03/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1739 TERMINO AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90804-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-498-0203
-----------------------------------------------------
Fax | 562-498-0223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1739 TERMINO AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90804-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-498-0203
-----------------------------------------------------
Fax | 562-498-0223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MR. ANGELITO D CADIENTE
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 562-498-0203
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------