Provider Demographics
NPI:1619575511
Name:GRACIOUS CARE RECOVERY SOLUTIONS INC
Entity Type:Organization
Organization Name:GRACIOUS CARE RECOVERY SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-422-1949
Mailing Address - Street 1:3212 SHRINE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4353
Mailing Address - Country:US
Mailing Address - Phone:954-422-1949
Mailing Address - Fax:954-422-1950
Practice Address - Street 1:3212 SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4353
Practice Address - Country:US
Practice Address - Phone:954-422-1949
Practice Address - Fax:954-422-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility