ST. GRACE HOSPICE INC. NPI 1598809634

NPI Information

NPI: 1598809634
Provider Name: ST. GRACE HOSPICE, INC.
Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

CLIA Number: 05D2266456

Address:
904 W 9TH ST
UPLAND, CA
ZIP 91786
Phone: (909) 723-1175
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ST. GRACE HOSPICE, INC. is a hospice care community based in Upland, CA. ST. GRACE HOSPICE, INC. NPI is 1598809634. The provider is registered as an organization entity type.

The provider's business location address is:

904 W 9TH ST
UPLAND, CA
ZIP 91786-576
Phone: (909) 723-1175
Fax: (909) 723-1174

The provider's authorized official is Kathleen Janet Haywood .
The authorized official title is Administrator and has the following contact phone number (909) 723-1175.

The CLIA number assigned to this NPI record is 05D2266456 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/19/2007 and was last updated on 1/17/2011.

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	251G00000X	Hospice Care, Community Based		550000548	CALIFORNIA	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	1598809634	MEDICAID	CALIFORNIA
2	551545	MEDICARE PIN	CALIFORNIA

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: 4/28/2024

NPI Synchronization or Removal

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