Provider Demographics
NPI:1760829485
Name:GRANT ME THE COURAGE RECOVERY
Entity Type:Organization
Organization Name:GRANT ME THE COURAGE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-262-9521
Mailing Address - Street 1:3350 E BIRCH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6266
Mailing Address - Country:US
Mailing Address - Phone:877-290-2058
Mailing Address - Fax:866-659-9110
Practice Address - Street 1:3350 E BIRCH ST STE 101
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6266
Practice Address - Country:US
Practice Address - Phone:877-290-2058
Practice Address - Fax:866-659-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)