Provider Demographics
NPI:1831712801
Name:GRACE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:GRACE FAMILY MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:POVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:561-317-2389
Mailing Address - Street 1:11191 GRANDVIEW MNR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8840
Mailing Address - Country:US
Mailing Address - Phone:561-317-2389
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD STE 211
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3275
Practice Address - Country:US
Practice Address - Phone:561-331-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty