Provider Demographics
NPI:1598180515
Name:GRACE EXTENDED & MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:GRACE EXTENDED & MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-212-2575
Mailing Address - Street 1:5050 LAGUNA BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4151
Mailing Address - Country:US
Mailing Address - Phone:916-212-2575
Mailing Address - Fax:
Practice Address - Street 1:901 H ST
Practice Address - Street 2:310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1805
Practice Address - Country:US
Practice Address - Phone:916-212-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64140Medicare UPIN