MEDICARE: GRACE HEALTH SYTEMS 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245946763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HEALTH SYTEMS LLC

Provider Business Mailing Address
First Line	:	4627 E PEARCE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1126
Country	:	US
Telephone Number	:	952-649-0366
Fax Number	:

Provider Business Practice Location Address
First Line	:	4627 E PEARCE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1126
Country	:	US
Telephone Number	:	952-649-0366
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANDHIR MAHARAJ
Credential	:	RN
Telephone Number	:	602-466-8352

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	01/27/2023

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