Provider Demographics
NPI:1831875038
Name:ST GRACE HOSPICE HOUSE, INC
Entity type:Organization
Organization Name:ST GRACE HOSPICE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:951-545-4462
Mailing Address - Street 1:1476 W 9TH ST STE B1
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5699
Mailing Address - Country:US
Mailing Address - Phone:951-545-4462
Mailing Address - Fax:
Practice Address - Street 1:1351 5TH AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3311
Practice Address - Country:US
Practice Address - Phone:909-870-5330
Practice Address - Fax:909-252-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based