Provider Demographics
NPI:1326032137
Name:GRACE HOME HEALTH CARE
Entity Type:Organization
Organization Name:GRACE HOME HEALTH CARE
Other - Org Name:GRACE HOME HEALTH CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELITO
Authorized Official - Middle Name:D
Authorized Official - Last Name:CADIENTE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:562-498-0203
Mailing Address - Street 1:1739 TERMINO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2121
Mailing Address - Country:US
Mailing Address - Phone:562-498-0203
Mailing Address - Fax:562-498-0223
Practice Address - Street 1:1739 TERMINO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2121
Practice Address - Country:US
Practice Address - Phone:562-498-0203
Practice Address - Fax:562-498-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57613FMedicaid
CAZZZ03422ZOtherBLUESHIELD OF CA
CAHHA57613FMedicaid