Provider Demographics
NPI:1992177893
Name:GRACE BEHAVIORAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-681-2500
Mailing Address - Street 1:780 FISHERMAN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3806
Mailing Address - Country:US
Mailing Address - Phone:305-681-2500
Mailing Address - Fax:305-681-2525
Practice Address - Street 1:780 FISHERMAN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3806
Practice Address - Country:US
Practice Address - Phone:305-681-2500
Practice Address - Fax:305-681-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management