Provider Demographics
NPI:1902158025
Name:GRACIOUS CARE RECOVERY
Entity Type:Organization
Organization Name:GRACIOUS CARE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-201-2265
Mailing Address - Street 1:635 SE 10TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5607
Mailing Address - Country:US
Mailing Address - Phone:754-201-2265
Mailing Address - Fax:
Practice Address - Street 1:635 SE 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5607
Practice Address - Country:US
Practice Address - Phone:754-201-2265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder