1265256762 NPI number — AGING GRACEFULLY CARE HOMES LLC

Table of content: BRUCE DAVID WASLICK MD (NPI 1750464954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265256762 NPI number — AGING GRACEFULLY CARE HOMES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGING GRACEFULLY CARE HOMES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265256762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1895 AVENIDA DEL ORO UNIT 6605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92052-0306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-207-6488
Provider Business Mailing Address Fax Number:
760-444-6464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3218 MIRA MESA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-206-3398
Provider Business Practice Location Address Fax Number:
760-444-6464
Provider Enumeration Date:
11/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
PALAD
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-207-6488

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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