MEDICARE: GRACE EXTENDED & MEDICAL SERVICES INC

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	207R00000X	Internal Medicine Physician	A055920	CA

General Provider Information

NPI Number	:	1598180515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE EXTENDED & MEDICAL SERVICES INC

Provider Business Mailing Address
First Line	:	5050 LAGUNA BLVD STE 112
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-4151
Country	:	US
Telephone Number	:	916-212-2575
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 H ST
Second Line	:	310
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-1805
Country	:	US
Telephone Number	:	916-212-2575
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARVIND KAUR BEHL
Credential	:	M.D
Telephone Number	:	916-212-2575

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	08/25/2021

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