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General NPI Number Information
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NPI Number | 1811552680
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Entity Type | Organization
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Legal Business Name | GRACE AND GLORY HOSPICE, INC.
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 2145 ELKINS WAY STE A
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City | BRENTWOOD
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State | CA
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Zip | 94513-7363
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Country | US
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Telephone | 925-565-3913
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Fax | 925-206-4192
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Provider Business Mailing Address
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Address Line | 1563 EGRET DR
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City | TRACY
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State | CA
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Zip | 95376-8318
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Country | US
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Telephone | 925-565-3913
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Fax | 925-206-4192
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JANE PORTER
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Credential |
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Telephone | 650-898-5784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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