Provider Demographics
NPI:1982025938
Name:GRACIOUS CARE RECOVERY SOLUTIONS, INC.
Entity Type:Organization
Organization Name:GRACIOUS CARE RECOVERY SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-422-1949
Mailing Address - Street 1:201 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3621
Mailing Address - Country:US
Mailing Address - Phone:954-422-1949
Mailing Address - Fax:954-422-1950
Practice Address - Street 1:201 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3621
Practice Address - Country:US
Practice Address - Phone:954-422-1949
Practice Address - Fax:954-422-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder