Organization
GRACELIGHT COMMUNITY HEALTH
Active
Organization
GRACELIGHT COMMUNITY HEALTH
Active
Other names
QueensCare Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELOISA PERARD (PRESIDENT AND CEO)
(323) 669-4321
Entity
Organization
Contact information
Practice address
4816 E 3RD ST, LOS ANGELES, CA 90022-1602
(323) 780-4510
(323) 780-6132
Mailing address
4816 E 3RD ST, LOS ANGELES, CA 90022-1602
(323) 780-4510
(323) 981-1662
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1019
MEDICARE FQHC PROVIDER NUMBER
CA
05
—
CMM70660F
—
CA
01
—
W6997D
MEDICARE PROVIDER NUMBER
CA
Enumeration date
09/15/2008
Last updated
10/29/2025
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