MEDICARE: HAZAEL GRACE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1003758467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZAEL GRACE HOME CARE LLC

Provider Business Mailing Address
First Line	:	4302 E JANICE WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-8101
Country	:	US
Telephone Number	:	602-708-2897
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 E JANICE WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-8101
Country	:	US
Telephone Number	:	602-708-2897
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GARMEI SACKOR
Credential	:
Telephone Number	:	602-708-2897

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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