Provider Demographics
NPI:1740835743
Name:GRACELIGHT COMMUNITY HEALTH
Entity type:Organization
Organization Name:GRACELIGHT COMMUNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-669-4321
Mailing Address - Street 1:4816 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1602
Mailing Address - Country:US
Mailing Address - Phone:323-780-4510
Mailing Address - Fax:323-981-1662
Practice Address - Street 1:303 LOMA DR STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1103
Practice Address - Country:US
Practice Address - Phone:323-635-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)