Provider Demographics
NPI:1770259129
Name:GRACE OF ANGEL PARK LLC
Entity Type:Organization
Organization Name:GRACE OF ANGEL PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-232-4602
Mailing Address - Street 1:7865 RANCHO MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1239
Mailing Address - Country:US
Mailing Address - Phone:702-232-4602
Mailing Address - Fax:702-331-9187
Practice Address - Street 1:8617 HIGHLAND VIEW AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5709
Practice Address - Country:US
Practice Address - Phone:702-232-4602
Practice Address - Fax:702-331-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home