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General NPI Number Information
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NPI Number | 1851019210
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Entity Type | Organization
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Legal Business Name | GRACE OF ROSA LLC
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 27317 MANZANITA LN APT 205
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-5114
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Country | US
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Telephone | 619-874-3443
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Fax |
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Provider Business Mailing Address
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Address Line | 27317 MANZANITA LN APT 205
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-5114
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Country | US
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Telephone | 619-874-3443
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Fax |
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Authorized Official
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Title or Position | CEO-NURSE
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Name | KRYSTAL JANAE BLUNT
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Credential | LVN/LPN
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Telephone | 619-874-3443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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