=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447506506
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE HOSPICE AND PALLIATIVE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2012
-----------------------------------------------------
Last Update Date | 07/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 CAMINO RAMON STE 135
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-858-8864
-----------------------------------------------------
Fax | 510-614-5882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2410 CAMINO RAMON STE 135
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-858-8864
-----------------------------------------------------
Fax | 510-614-5882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. SEUNG HO CHOI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 213-445-1140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------