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General NPI Number Information
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NPI Number | 1629765649
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Entity Type | Organization
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Legal Business Name | GRACE IMPACT HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 3415 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90034-6060
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Country | US
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Telephone | 661-578-2365
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90034-6060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ESTHER DAVID-OLADOYE
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Credential |
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Telephone | 661-578-2365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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