Organization
ST GRACE MANOR, INC
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN JANET HAYWOOD N/A (ADMINISTRATOR)
(951) 545-4462
Entity
Organization
Contact information
Practice address
804 W 8TH ST, UPLAND, CA 91786-6401
(951) 545-4462
Mailing address
804 W 8TH ST, UPLAND, CA 91786-6401
(951) 545-4462
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
CA
Enumeration date
06/10/2016
Last updated
06/10/2016
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