Provider Demographics
NPI:1881217685
Name:GRACE MEDICAL CARE
Entity Type:Organization
Organization Name:GRACE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEFOWOJU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, PMHNP-BC
Authorized Official - Phone:908-693-5036
Mailing Address - Street 1:1379 BROOKFALL AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7013
Mailing Address - Country:US
Mailing Address - Phone:908-693-5036
Mailing Address - Fax:862-849-2319
Practice Address - Street 1:422 GRAND ST # 9-10
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2727
Practice Address - Country:US
Practice Address - Phone:908-693-5036
Practice Address - Fax:862-849-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty