institution
Gracelight Community Health
Federally Qualified Health Center (FQHC) in Los Angeles, California
NPI 1104075282

Gracelight Community Health is a Federally Qualified Health Center (FQHC) based in Los Angeles, CA and is specialized in Federally Qualified Health Center (FQHC). Gracelight Community Health practices in Los Angeles, CA. The NPI Number for Gracelight Community Health is 1104075282 and holds a License No. (California).

The current practice location address for Gracelight Community Health is 4816 E 3Rd St, Los Angeles, CA and can be reached out via phone at 323-780-4510 and via fax at 323-780-6132.

Location: 4816 E 3Rd St, Los Angeles, CA, 90022-1602
institution
Provider Profile Details
NPI Number
1104075282
Provider Name
Gracelight Community Health
Credential
Provider Entity Type
Organization
Address
4816 E 3Rd St, Los Angeles, CA, 90022-1602
Phone Number
323-780-4510
Fax Number
323-780-6132
Provider Enumeration Date
09/15/2008
Last Update Date
08/17/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
W6997D 01 CA MEDICARE PROVIDER NUMBER
CMM70660F 05 CA
55-1019 01 CA MEDICARE FQHC PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
4816 E 3Rd St
City
State
Zip
90022-1602
Phone Number
323-780-4510
Fax Number
323-780-6132
person
Provider Business Mailing Address Details
Address
4816 E 3Rd St
City
State
Zip
90022-1602
Phone Number
323-780-4510
Fax Number
323-780-6132
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Federally Qualified Health Center (FQHC)
Taxonomy
License No.
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Definition
Definition to come...
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