Provider Demographics
NPI:1316599590
Name:GRACEY HOLISTIC HEALTH
Entity Type:Organization
Organization Name:GRACEY HOLISTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIGHT
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:617-549-1196
Mailing Address - Street 1:75 STRATHMORE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7738
Mailing Address - Country:US
Mailing Address - Phone:617-549-1196
Mailing Address - Fax:617-549-1119
Practice Address - Street 1:320 WASHINGTON ST STE 402
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6873
Practice Address - Country:US
Practice Address - Phone:617-549-1196
Practice Address - Fax:617-566-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service