Amazing Grace Oasis II

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

Legal business name

AMAZING GRACE OASIS II

Practice address

8708 Bridgeport Ave
Hesperia, CA 92344-5562

Phone

(818) 572-3956

Fax

(818) 925-3011

NPI assigned

Nov 7, 2018

Last updated

Nov 7, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eileen Andreasyan, PHARMD

Title

Administrator

Phone

(818) 572-3956

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396213302. Details of each certification follow.

• CCN 55G792 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G792

Legal name

AMAZING GRACE OASIS II

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Mar 29, 2021

Last certification

Jul 29, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

8708 Bridgeport Ave
Hesperia, CA 92344

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": "1541548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1396213302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8708 BRIDGEPORT AVE",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923445562",
            "telephone_number": "818-572-3956",
            "fax_number": "818-925-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8708 BRIDGEPORT AVE",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923445562",
            "telephone_number": "818-572-3956",
            "fax_number": "818-925-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE OASIS II",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-07",
        "last_updated": "2018-11-07",
        "status": "A",
        "authorized_official_last_name": "ANDREASYAN",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-572-3956",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruby Victoria Alzaga
• Am Pharmacy Inc (Am Pharmacy)
• Yvonne Amador, MSW
• Amazing Grace Hospice Inc
• Amazing Grace Oasis
• Amazing Grace Oasis III
• Daisy Lupe Anaya
• Alexis Anderson
• Fred L Anderson, DPM
• Luisa Daniela Andrade

• Mental Illness Intermediate Care Facility in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Mental Illness Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.