MEDICARE: GRACEFUL SENESCENCE

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	261Q00000X	Clinic/Center	060000630	CA
2	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033221452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFUL SENESCENCE

Provider Business Mailing Address
First Line	:	120 W EL SEGUNDO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-1628
Country	:	US
Telephone Number	:	310-538-5808
Fax Number	:	310-538-5406

Provider Business Practice Location Address
First Line	:	120 W EL SEGUNDO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-1628
Country	:	US
Telephone Number	:	310-538-5808
Fax Number	:	310-538-5406

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHARON SELICO
Credential	:
Telephone Number	:	323-293-7072

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/03/2023

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Directions to “GRACEFUL SENESCENCE ” Practice Location

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