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General NPI Number Information
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NPI Number | 1609736875
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Entity Type | Organization
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Legal Business Name | GRACE AT HOME PC
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 111 W. OCEAN BLVD FLOOR 4, ROOM 450
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City | LONG BEACH
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State | CA
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Zip | 90802
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Country | US
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Telephone | 844-401-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 564 NIAGARA ST BLDG 2
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City | BUFFALO
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State | NY
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Zip | 14201-1108
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Country | US
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Telephone | 716-882-0366
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Fax | 716-306-4177
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Authorized Official
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Title or Position | CEO
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Name | RODNEY ARMSTEAD
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Credential | MD
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Telephone | 716-361-0591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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