Provider Demographics
NPI:1518169457
Name:GRACE & ELEGANCE ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:GRACE & ELEGANCE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILAI
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER -OWNER
Authorized Official - Phone:480-844-5911
Mailing Address - Street 1:949 N STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5603
Mailing Address - Country:US
Mailing Address - Phone:480-844-5911
Mailing Address - Fax:480-733-9005
Practice Address - Street 1:949 N STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5603
Practice Address - Country:US
Practice Address - Phone:480-844-5911
Practice Address - Fax:480-733-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH2311310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility