Provider Demographics
NPI:1649066457
Name:GRACEY'S VISION HEALTHCARE INC.
Entity type:Organization
Organization Name:GRACEY'S VISION HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-403-9118
Mailing Address - Street 1:8 LOMBARDY ST STE 127
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3210
Mailing Address - Country:US
Mailing Address - Phone:862-403-9118
Mailing Address - Fax:877-437-7795
Practice Address - Street 1:56 HAMILTON STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505
Practice Address - Country:US
Practice Address - Phone:862-403-9118
Practice Address - Fax:877-437-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder