Provider Demographics
NPI:1558905380
Name:GRACE COMMUNITY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:GRACE COMMUNITY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:609-678-8266
Mailing Address - Street 1:100 MELVILLE LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2912
Mailing Address - Country:US
Mailing Address - Phone:609-678-8266
Mailing Address - Fax:
Practice Address - Street 1:100 MELVILLE LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2912
Practice Address - Country:US
Practice Address - Phone:609-678-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder