Provider Demographics
NPI:1275809402
Name:GRASS ROOTS RECOVERY
Entity Type:Organization
Organization Name:GRASS ROOTS RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-313-4562
Mailing Address - Street 1:516 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7602
Mailing Address - Country:US
Mailing Address - Phone:561-313-4562
Mailing Address - Fax:561-444-2715
Practice Address - Street 1:719 PLACE CHATEAU
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2212
Practice Address - Country:US
Practice Address - Phone:561-313-4562
Practice Address - Fax:561-444-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness