Provider Demographics
NPI:1437766375
Name:GRACE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLOKWU
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:908-417-0632
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733-0046
Mailing Address - Country:US
Mailing Address - Phone:908-417-0632
Mailing Address - Fax:
Practice Address - Street 1:1140 BURNT TAVERN RD STE 1A
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1496
Practice Address - Country:US
Practice Address - Phone:908-417-0632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health