# GRACE OF ROSA LLC

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

## Provider details

- **NPI number:** 1851019210
- **Authorized official:** KRYSTAL JANAE BLUNT LVN/LPN (CEO-NURSE)
- **Authorized official phone:** (619) 874-3443

## Contact information

- **Practice address:** 27317 MANZANITA LN APT 205, CANYON COUNTRY, CA 91387-5114
- **Practice address phone:** (619) 874-3443
- **Mailing address:** 27317 MANZANITA LN APT 205, CANYON COUNTRY, CA 91387-5114
- **Mailing address phone:** (619) 874-3443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 08/19/2022
- **Last updated:** 08/19/2022