ST. GRACE MANOR 2
NPI 1164964383
Nursing Facility/Intermediate Care Facility in Montclair, CA

Q: What is St, Grace Hospice, Inc.'s NPI number?

The NPI number for St, Grace Hospice, Inc. is 1164964383. It was assigned to this organization in the NPPES registry on November 7, 2016. The provider is doing business as St. Grace Manor 2.

Q: What is St, Grace Hospice, Inc.'s specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Active since November 07, 2016CLIA 05D2200588 · Waiver

4440 FAUNA ST, MONTCLAIR, CA 91763(951) 545-4462 Get Directions Write a Review

NPPES record last updated: November 7, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About St. Grace Manor 2 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. GRACE MANOR 2 (NPI 1164964383) is a healthcare organization registered as a nursing facility/intermediate care facility in Montclair, California and active in the NPI registry since November 2016. The organization holds a CLIA Waiver certificate valid through November 15, 2026 and lists Kathleen Janet Haywood, Administrator, as its authorized official.

NPPES Registry Identity

NPI1164964383

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NameST, GRACE HOSPICE, INC.

Location Address4440 FAUNA STMontclair, CA 91763-3523

Mailing Address4440 Fauna StMontclair, CA 91763-3523 · (951) 545-4462

Phone(951) 545-4462

Organization SubpartNo

Authorized OfficialKathleen Janet HaywoodAdministrator · (951) 545-4462

Enumeration DateNovember 7, 2016

✔ NPI 1164964383 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

Definition

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

4440 FAUNA ST, Montclair, CA 91763

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Other Names 1

Doing Business AsSt. Grace Manor 2

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2200588

St. Grace Manor, Inc · Montclair, CA

Active · expires Nov 15, 2026

CLIA Number05D2200588

Laboratory TypeIntermediate Care Facility For Mentally Retarded

Certificate Effective DateNovember 16, 2024

Certificate Expiration DateNovember 15, 2026

Laboratory DirectorMally Redley

Laboratory Phone(909) 577-0110

Laboratory LocationSt. Grace Manor, Inc4440 Fauna Street, Montclair, CA 91763

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St, Grace Hospice, Inc.'s NPI number?

The NPI number for St, Grace Hospice, Inc. is 1164964383. It was assigned to this organization in the NPPES registry on November 7, 2016. The provider is doing business as St. Grace Manor 2.

Where is St, Grace Hospice, Inc. located?

St, Grace Hospice, Inc. is located at 4440 Fauna St, Montclair, CA 91763. The listed phone number is (951) 545-4462.

What is St, Grace Hospice, Inc.'s specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Does St, Grace Hospice, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2200588) is associated with this NPI, valid through November 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for St, Grace Hospice, Inc. was last updated on November 7, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.