Provider Demographics
NPI:1720619810
Name:GRATEFUL HEALLING LLC
Entity Type:Organization
Organization Name:GRATEFUL HEALLING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VETERINARAIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:520-881-2103
Mailing Address - Street 1:5065 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2113
Mailing Address - Country:US
Mailing Address - Phone:520-881-2103
Mailing Address - Fax:520-881-1059
Practice Address - Street 1:5065 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2113
Practice Address - Country:US
Practice Address - Phone:520-881-2103
Practice Address - Fax:520-881-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center