# GRACE HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750368387
- **Authorized official:** MR. ROBERT ISAAC RN (ADMINISTRATOR)
- **Authorized official phone:** (209) 394-2440

## Contact information

- **Practice address:** 13435 PEACH AVE, LIVINGSTON, CA 95334-9312
- **Practice address phone:** (209) 394-2440
- **Practice address fax:** (209) 394-8430
- **Mailing address:** 13435 PEACH AVE, LIVINGSTON, CA 95334-9312
- **Mailing address phone:** (209) 394-2440
- **Mailing address fax:** (209) 394-8430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 040000171 | CA | Yes |

## Other

- **Enumeration date:** 12/23/2005
- **Last updated:** 03/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR18421F | — | CA |