Organization
GIFT OF GRACE RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENISHA FANIEL (ADMINISTRATOR)
(323) 400-9462
Entity
Organization
Contact information
Practice address
126 W 46TH ST, LOS ANGELES, CA 90037-2722
(323) 400-9462
Mailing address
611 WILSHIRE BLVD STE 900, LOS ANGELES, CA 90017-2905
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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