St, Grace Hospice, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

ST, GRACE HOSPICE, INC.

Doing business as

St. Grace Manor 2

Practice address

4440 Fauna St
Montclair, CA 91763-3523

Phone

(951) 545-4462

NPI assigned

Nov 7, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Kathleen Janet Haywood

Title

Administrator

Phone

(951) 545-4462

Specialties & licenses 1

Addresses

Other names 1

• ST. GRACE MANOR 2 Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1164964383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 FAUNA ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917633523",
            "telephone_number": "951-545-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 FAUNA ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917633523",
            "telephone_number": "951-545-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST, GRACE HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "JANET",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "951-545-4462",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. GRACE MANOR 2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nursing Facility/Intermediate Care Facility in Montclair, CA
• Providers in Montclair, CA by specialty
• Nursing Facility/Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.