Provider Demographics
NPI:1811552680
Name:GRACE AND GLORY HOSPICE, INC.
Entity Type:Organization
Organization Name:GRACE AND GLORY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-898-5784
Mailing Address - Street 1:2206 EASTPORT DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:925-206-4192
Practice Address - Street 1:101 WALDIE PLZ STE 11
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1279
Practice Address - Country:US
Practice Address - Phone:650-898-5784
Practice Address - Fax:925-206-4192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based