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NPI Code Detail

MEDICARE: GRACE HANSON

MEDICARE: GRACE HANSON
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
1310400000XAssisted Living FacilityALM-011231AZ

General Provider Information

NPI Number : 1194423699
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE HANSON
Provider Business Mailing Address
First Line : 3445 W ACOMA DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85053-5620
Country : US
Telephone Number : 602-698-1902
Fax Number : 602-698-1904
Provider Business Practice Location Address
First Line : 3445 W ACOMA DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85053-5620
Country : US
Telephone Number : 602-698-1902
Fax Number : 602-698-1904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2023
Last Update Date : 02/23/2023

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Directions to “ GRACE HANSON ” Practice Location

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