Provider Demographics
NPI:1023190980
Name:GRACE HOME
Entity Type:Organization
Organization Name:GRACE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JACINTO
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-989-2184
Mailing Address - Street 1:9260 LOMA LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4216
Mailing Address - Country:US
Mailing Address - Phone:916-989-2184
Mailing Address - Fax:916-987-1555
Practice Address - Street 1:9260 LOMA LN
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4216
Practice Address - Country:US
Practice Address - Phone:916-989-2184
Practice Address - Fax:916-987-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340314987311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home