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General NPI Number Information
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NPI Number | 1700532298
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Entity Type | Organization
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Legal Business Name | GRACE RETIREMENT VILLAGE, INC.
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 1100 E WHITTIER BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-3962
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Country | US
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Telephone | 562-694-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E WHITTIER BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-3962
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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 | ADMINISTRATOR
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Name | ERIK T. DOAN
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Credential |
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Telephone | 714-227-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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