Eternal Grace Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ETERNAL GRACE HOSPICE, INC.

Practice address

9613 Arrow Rte Ste B
Rancho Cucamonga, CA 91730-4552

Phone

(818) 616-6260

Fax

(818) 465-9255

NPI assigned

Apr 5, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Seema Khullar

Title

Ceo

Phone

(818) 616-6260

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B41665

Legal name

ETERNAL GRACE HOSPICE, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 9, 2022

Last certification

Sep 9, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 21, 2019 in CA

Enrollment address

6742 Van Nuys Blvd
Ste 102
Van Nuys, CA 91405-4611

Listed as

Eternal Grace Hospice, IncCCN B41665 · All quality measures

Certified

Sep 9, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1003378142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9613 ARROW RTE STE B",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304552",
            "telephone_number": "818-616-6260",
            "fax_number": "818-465-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9613 ARROW RTE STE B",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304552",
            "telephone_number": "818-616-6260",
            "fax_number": "818-465-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNAL GRACE HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-05",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "KHULLAR",
        "authorized_official_first_name": "SEEMA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-616-6260"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.