| Gracelight Community Health | |
|
4618 Fountain Ave Los Angeles CA 90029-1830 | |
| (323) 953-7170 | |
| (323) 663-2379 |
| Full Name | Gracelight Community Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 4618 Fountain Ave, Los Angeles, California |
| Authorized Official Name and Position | Eloisa Perard (PRESIDENT & CEO) |
| Authorized Official Contact | 3236694321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gracelight Community Health 4816 E 3rd St Los Angeles CA 90022-1602 Ph: (323) 669-4302 | Gracelight Community Health 4618 Fountain Ave Los Angeles CA 90029-1830 Ph: (323) 953-7170 |
| NPI Number | 1639241888 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 06/27/2024 |
| Medicare PECOS PAC ID | 3072619618 |
|---|---|
| Medicare Enrollment ID | O20100811000484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639241888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 960000926 (California) | Primary |
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