Provider Demographics
NPI:1023652914
Name:GRACE GERIATRIC CARE INC
Entity type:Organization
Organization Name:GRACE GERIATRIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TRUNG-THUY
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:949-877-9194
Mailing Address - Street 1:8883 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2608
Mailing Address - Country:US
Mailing Address - Phone:657-208-2221
Mailing Address - Fax:657-400-9174
Practice Address - Street 1:8883 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2608
Practice Address - Country:US
Practice Address - Phone:657-208-2221
Practice Address - Fax:657-400-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty