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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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