Provider Demographics
NPI:1245821966
Name:GRACE LAND RECOVERY LLC
Entity type:Organization
Organization Name:GRACE LAND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ARIC
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-620-9745
Mailing Address - Street 1:134 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4291
Mailing Address - Country:US
Mailing Address - Phone:901-519-2655
Mailing Address - Fax:404-698-1497
Practice Address - Street 1:134 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4291
Practice Address - Country:US
Practice Address - Phone:901-519-2655
Practice Address - Fax:404-698-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center