Provider Demographics
NPI:1679241350
Name:GRACE RECOVERY AND WELLNESS
Entity Type:Organization
Organization Name:GRACE RECOVERY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCADC
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAGE-ALIPERTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:732-778-4737
Mailing Address - Street 1:4 NED DR
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2710
Mailing Address - Country:US
Mailing Address - Phone:732-778-4737
Mailing Address - Fax:
Practice Address - Street 1:4 NED DR
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2710
Practice Address - Country:US
Practice Address - Phone:732-778-4737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty