Provider Demographics
NPI:1629222526
Name:HOSPICE OF GRACE, INC
Entity Type:Organization
Organization Name:HOSPICE OF GRACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARPINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESTENIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-553-6646
Mailing Address - Street 1:815 E COLORADO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1200
Mailing Address - Country:US
Mailing Address - Phone:818-553-6646
Mailing Address - Fax:818-553-6656
Practice Address - Street 1:815 E COLORADO ST
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1200
Practice Address - Country:US
Practice Address - Phone:818-553-6646
Practice Address - Fax:818-553-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3133017251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based