Organization
GRACELIGHT COMMUNITY HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA SNITMAN (CHIEF OPERATING OFFICER)
(323) 635-1153
Entity
Organization
Contact information
Practice address
5000 W SUNSET BLVD STE 401, LOS ANGELES, CA 90027-5861
(323) 953-7170
Mailing address
4816 E 3RD ST, LOS ANGELES, CA 90022-1602
(323) 635-1153
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1895
MEDICARE FQHC PROVIDER NUMBER
CA
05
—
CMM70660F
—
CA
01
—
FHC70660F
MEDI-CAL FQHC PROVIDER NUMBER
CA
01
—
W6997D
MEDICARE PROVIDER NUMBER
CA
Enumeration date
06/24/2014
Last updated
12/31/2025
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