Active NPI
Grace Mullen
- Assisted Living Facility
- Tracy, CA
National Provider Identifier
1700331071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 397003708
- Practice address
- 641 Tracey Jean CT
Tracy, CA 95377-8685 - Phone
- (209) 640-7414
- NPI assigned
- Aug 16, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 397003708 | CA | Primary |
Addresses
Primary practice location
641 Tracey Jean CT
Tracy, CA 95377-8685
Mailing address
641 Tracey Jean CT
Tracy, CA 95377-8685
Phone (209) 640-7414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 397003708 | CA | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471305600000",
"number": "1700331071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "641 TRACEY JEAN CT",
"city": "TRACY",
"state": "CA",
"postal_code": "953778685",
"telephone_number": "209-640-7414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "641 TRACEY JEAN CT",
"city": "TRACY",
"state": "CA",
"postal_code": "953778685",
"telephone_number": "209-640-7414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLEN",
"first_name": "GRACE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-16",
"last_updated": "2016-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "CA",
"license": "397003708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.