NPIMap

Organization Active NPI

United Nursing Personal Care, Inc

Doing business as GraceLight Homecare

  • Home Health Agency
  • Victorville, CA
National Provider Identifier
1841591062
Registry record updated Nov 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1000163 Issued in CA
Legal business name
UNITED NURSING PERSONAL CARE, INC
Doing business as
GraceLight Homecare
Practice address
16044 Bear Valley Rd Ste 5
Victorville, CA 92395-8981
Phone
(760) 241-3800
Fax
(760) 241-3855
NPI assigned
Nov 4, 2010
Last updated
Nov 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2015

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

Authorized official

Name
Mrs. Sandra Elizabeth ChavarriaNPI 1780941849
Title
Owner
Phone
(760) 694-7345

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1000163 CA Primary

Addresses

Primary practice location

16044 Bear Valley Rd Ste 5
Victorville, CA 92395-8981

Mailing address

11039 Mesa Linda St
Victorville, CA 92392-4812
Phone (760) 241-3800

Other identifiers 1

IdentifierTypeStateIssuer
00697717OtherCACNA

Other names 1

  • GraceLight Homecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110531000131 CA Part A Provider - Home Health Agency 0042497034 Practice locations: Victorville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841591062. Details of each certification follow.

Home health agency certification: CCN 059597

Legal name
UNITED NURSING PERSONAL CARE, INC
Doing business as
GRACELIGHT HOMECARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 17, 2014
Last certification
Mar 6, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 30, 2010 in CA
Enrollment address
14070 Hesperia Rd
Ste 102
Victorville, CA 92395-4559

Care Compare: Home health agency

Medicare Care Compare
Listed as
Gracelight Home HealthCCN 059597 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Jun 17, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

14070 Hesperia Rd
Ste 102
Victorville, CA 92395
Phone (760) 241-3800

16044 Bear Valley Rd
Ste 5
Victorville, CA 92395
Phone (760) 241-3800

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Sandra E Chavarria Individual 5% Or Greater Direct Ownership Interest Aug 30, 2010 100%
Corporate DirectorDirector Aug 30, 2010 100%
W-2 Managing EmployeeDirector Aug 30, 2010 100%

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1841591062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11039 MESA LINDA ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923924812",
            "telephone_number": "760-241-3800",
            "fax_number": "760-241-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16044 BEAR VALLEY RD STE 5",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923958981",
            "telephone_number": "760-241-3800",
            "fax_number": "760-241-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED NURSING PERSONAL CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "CHAVARRIA",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-694-7345",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "1000163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNA",
            "identifier": "00697717",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GraceLight Homecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.