Provider Demographics
NPI:1710599030
Name:GRACIOUS CARE HOMES INC.
Entity Type:Organization
Organization Name:GRACIOUS CARE HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-316-2946
Mailing Address - Street 1:8705 ROGUE RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5518
Mailing Address - Country:US
Mailing Address - Phone:951-316-2946
Mailing Address - Fax:714-368-4627
Practice Address - Street 1:14661 BROOKLINE WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2517
Practice Address - Country:US
Practice Address - Phone:714-368-4627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306004321OtherCCLD