Provider Demographics
NPI:1194420729
Name:HOUSE OF GRACE HOME CARE, LLC
Entity type:Organization
Organization Name:HOUSE OF GRACE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARFOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-691-6000
Mailing Address - Street 1:PO BOX 30303
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-9303
Mailing Address - Country:US
Mailing Address - Phone:925-691-6000
Mailing Address - Fax:
Practice Address - Street 1:5112 GOLETA CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8300
Practice Address - Country:US
Practice Address - Phone:925-691-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care