Provider Demographics
NPI:1376009746
Name:GRACE ELDERCARE, RCFE
Entity Type:Organization
Organization Name:GRACE ELDERCARE, RCFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:510-233-9693
Mailing Address - Street 1:2610 FRANCISCO WAY
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1531
Mailing Address - Country:US
Mailing Address - Phone:510-233-9693
Mailing Address - Fax:510-215-9402
Practice Address - Street 1:2610 FRANCISCO WAY
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1531
Practice Address - Country:US
Practice Address - Phone:510-233-9693
Practice Address - Fax:510-215-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home