Provider Demographics
NPI:1326564279
Name:SAVING GRACE CARE LLC
Entity Type:Organization
Organization Name:SAVING GRACE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-475-8657
Mailing Address - Street 1:5502 N LARKIN DR
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5717
Mailing Address - Country:US
Mailing Address - Phone:626-475-8657
Mailing Address - Fax:626-628-3900
Practice Address - Street 1:3601 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-2358
Practice Address - Country:US
Practice Address - Phone:626-475-8657
Practice Address - Fax:626-628-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8G22203343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
194700115OtherDEPARTMENT OF SOCIAL SERVICES-HOMECARE ORGANIZATION LICENSE