Provider Demographics
NPI:1821970492
Name:GOD'S GRACE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:GOD'S GRACE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAZIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCARNADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-765-7128
Mailing Address - Street 1:15826 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3144
Mailing Address - Country:US
Mailing Address - Phone:602-296-4057
Mailing Address - Fax:602-283-5897
Practice Address - Street 1:15826 N 10TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3144
Practice Address - Country:US
Practice Address - Phone:602-296-4057
Practice Address - Fax:602-283-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility