Provider Demographics
NPI:1427337179
Name:GRACE HEALTH INC
Entity type:Organization
Organization Name:GRACE HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-675-9191
Mailing Address - Street 1:18339 COLIMA RD STE A
Mailing Address - Street 2:STE A
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2792
Mailing Address - Country:US
Mailing Address - Phone:626-810-1056
Mailing Address - Fax:626-810-4470
Practice Address - Street 1:18339 COLIMA RD STE A
Practice Address - Street 2:STE A
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2792
Practice Address - Country:US
Practice Address - Phone:626-810-1056
Practice Address - Fax:626-810-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY524873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149936OtherPK
CA1427337179Medicaid