Provider Demographics
NPI:1922741818
Name:GRATEFUL HEARTS CARE HOME LLC
Entity Type:Organization
Organization Name:GRATEFUL HEARTS CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/RESIDENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-724-2735
Mailing Address - Street 1:1213 120TH ST S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-3801
Mailing Address - Country:US
Mailing Address - Phone:206-347-6080
Mailing Address - Fax:253-948-0194
Practice Address - Street 1:1213 120TH ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-3801
Practice Address - Country:US
Practice Address - Phone:206-347-6080
Practice Address - Fax:253-948-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA220389301OtherDSHS