Provider Demographics
NPI:1265018725
Name:ABJC GRACIOUS LIVING, INC.
Entity Type:Organization
Organization Name:ABJC GRACIOUS LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-622-0671
Mailing Address - Street 1:349 E KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-8227
Mailing Address - Country:US
Mailing Address - Phone:626-622-0671
Mailing Address - Fax:
Practice Address - Street 1:312 W ASTER ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2201
Practice Address - Country:US
Practice Address - Phone:626-622-0671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility