Provider Demographics
NPI:1740823632
Name:GRACE FAMILY HEALTH, INC.
Entity type:Organization
Organization Name:GRACE FAMILY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-231-1385
Mailing Address - Street 1:24910 LAS BRISAS RD STE 116
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4035
Mailing Address - Country:US
Mailing Address - Phone:951-231-1385
Mailing Address - Fax:951-461-9191
Practice Address - Street 1:24910 LAS BRISAS RD STE 116
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4035
Practice Address - Country:US
Practice Address - Phone:951-231-1385
Practice Address - Fax:951-461-9191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE FAMILY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care