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General NPI Number Information
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NPI Number | 1376009746
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Entity Type | Organization
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Legal Business Name | GRACE ELDERCARE, RCFE
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 2610 FRANCISCO WAY
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City | EL CERRITO
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State | CA
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Zip | 94530-1531
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Country | US
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Telephone | 510-233-9693
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Fax | 510-215-9402
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Provider Business Mailing Address
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Address Line | 2610 FRANCISCO WAY
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City | EL CERRITO
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State | CA
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Zip | 94530-1531
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Country | US
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Telephone | 510-233-9693
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Fax | 510-215-9402
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHANG LEE
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Credential | MANAGER
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Telephone | 510-233-9693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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