MEDICARE: AGING WITH GRACE HOUSING INITIATIVE

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	:	1215747274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGING WITH GRACE HOUSING INITIATIVE

Provider Business Mailing Address
First Line	:	3130 WEBSTER ST APT 14
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-3400
Country	:	US
Telephone Number	:	415-385-9523
Fax Number	:

Provider Business Practice Location Address
First Line	:	6464 VILLA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95842-2426
Country	:	US
Telephone Number	:	415-385-9523
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANDREAS MATHEW MEHALAKIS
Credential	:
Telephone Number	:	415-385-9523

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/11/2025

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Directions to “AGING WITH GRACE HOUSING INITIATIVE ” Practice Location

Language	Start Address	Practice Location

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