NPIMap

Organization Active NPI

Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1740835743
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRACELIGHT COMMUNITY HEALTH
Practice address
303 Loma Dr Ste 202
Los Angeles, CA 90017-1103
Phone
(323) 635-1140
NPI assigned
Aug 6, 2019
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Eloisa Perard
Title
President & Ceo
Phone
(323) 669-4321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

303 Loma Dr Ste 202
Los Angeles, CA 90017-1103

Mailing address

4816 E 3Rd St
Los Angeles, CA 90022-1602
Phone (323) 780-4510

Other names 1

  • Queenscare Health Centers Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170425001131 CA Part B Supplier - Clinic/Group Practice 3072619618 Receives reassigned benefits from 73 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA
O20200123000485 CA Part A Provider - Federally Qualified Health Center (FQHC) 3072619618 Practice locations: Los Angeles, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1740835743. Details of each certification follow.

Federally qualified health center certification: CCN 921825

Legal name
GRACELIGHT COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 13, 2019
Last certification
Dec 13, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 8, 1982 in CA
Enrollment address
303 Loma Dr
Ste 202
Los Angeles, CA 90017-1103

Federally qualified health center certification: CCN 051162

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ARROYO VISTA FAMILY HEALTH CENTER - LOMA DR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 20, 2009
Last certification
Mar 20, 2009
Ownership / control type
For profit – corporation
Facility address
303 South Loma Drive, Suite 202
Los Angeles, CA 90017

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2181711Gracelight Community Health303 Loma Dr Ste 202, Los Angeles, CA 90017Certificate of waiverApr 8, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Martha Arias Individual Corporate DirectorBoard Member Jan 1, 2016
Eloisa Perard Individual Corporate OfficerChief Executive Officer Jan 1, 2021
W-2 Managing Employee Jun 21, 2017
Alexander Cornelius Lawrence Individual Corporate DirectorBoard Member - Chair Jul 1, 2020
Aracely Navarro Individual Corporate DirectorBoard Member - Secretary Apr 1, 2023
Marina Snitman Individual Corporate OfficerChief Operating Officer Jul 1, 2020
W-2 Managing Employee Sep 21, 2015
Mateusz H Perek Individual Corporate OfficerChief Financial Officer Oct 13, 2025
W-2 Managing Employee Oct 13, 2025
Zoriy Elterman Individual Corporate DirectorBoard Member Mar 1, 2021

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gracelight Community HealthLos Angeles, CA, CCN 551895 Federally qualified health center Other Jul 1, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1740835743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4816 E 3RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900221602",
            "telephone_number": "323-780-4510",
            "fax_number": "323-981-1662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 LOMA DR STE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171103",
            "telephone_number": "323-635-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACELIGHT COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-06",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "PERARD",
        "authorized_official_first_name": "ELOISA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "323-669-4321"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queenscare Health Centers",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.