Provider Demographics
NPI:1164073052
Name:GRACIOUS CARE HOMES INC.
Entity Type:Organization
Organization Name:GRACIOUS CARE HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-316-2946
Mailing Address - Street 1:8705 ROGUE RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5518
Mailing Address - Country:US
Mailing Address - Phone:951-316-2946
Mailing Address - Fax:
Practice Address - Street 1:4110 E JORDAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-5429
Practice Address - Country:US
Practice Address - Phone:714-289-1946
Practice Address - Fax:714-289-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306003840OtherCCLD