Provider Demographics
NPI:1457248163
Name:GRACED PATH HEALTHCARE
Entity type:Organization
Organization Name:GRACED PATH HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIDINMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-675-0586
Mailing Address - Street 1:22837 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4155
Mailing Address - Country:US
Mailing Address - Phone:562-412-7857
Mailing Address - Fax:
Practice Address - Street 1:22837 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-4155
Practice Address - Country:US
Practice Address - Phone:562-412-7857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health