Organization
ST. GRACE HOSPICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN JANET HAYWOOD (ADMINISTRATOR)
(909) 723-1175
Entity
Organization
Contact information
Practice address
904 W 9TH ST, UPLAND, CA 91786-4576
(909) 723-1175
(909) 723-1174
Mailing address
904 W 9TH ST, UPLAND, CA 91786-4576
(909) 723-1175
(909) 723-1174
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
550000548
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598809634
—
CA
Enumeration date
02/19/2007
Last updated
01/17/2011
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