GRACIOUS CARE HOMES INC. NPI 1104438142

NPI Information

NPI: 1104438142
Provider Name: GRACIOUS CARE HOMES INC.
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
17602 AMAGANSET WAY
TUSTIN, CA
ZIP 92780
Phone: (714) 368-4659
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GRACIOUS CARE HOMES INC. is an assisted living facility in Tustin, CA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. GRACIOUS CARE HOMES INC. NPI is 1104438142. The provider is registered as an organization entity type.

The provider's business location address is:

17602 AMAGANSET WAY
TUSTIN, CA
ZIP 92780-514
Phone: (714) 368-4659

The provider's authorized official is David B. Nehem .
The authorized official title is Managing Member and has the following contact phone number (951) 316-2946.

The enumeration date for this NPI number is 8/20/2020 and was last updated on 8/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	306004322	OTHER	CALIFORNIA	CCLD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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