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Organization
GRACE OF ROSA LLC
Active
Organization
GRACE OF ROSA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL JANAE BLUNT LVN/LPN (CEO-NURSE)
(619) 874-3443
Entity
Organization
Contact information
Practice address
27317 MANZANITA LN APT 205, CANYON COUNTRY, CA 91387-5114
(619) 874-3443
Mailing address
27317 MANZANITA LN APT 205, CANYON COUNTRY, CA 91387-5114
(619) 874-3443
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
NULL
164W00000X
Licensed Practical Nurse
—
—
251B00000X
Case Management Agency
—
NULL
251E00000X
Home Health Agency
Primary
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
385H00000X
Respite Care
—
NULL
Other
Enumeration date
08/19/2022
Last updated
08/19/2022
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