Healthcare Provider Details

I. General information

NPI: 1225805856
Provider Name (Legal Business Name): GRATEFUL AND BEYOND RECOVERY HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 W LAMAR RD
GLENDALE AZ
85305-3421
US

IV. Provider business mailing address

8820 W LAMAR RD
GLENDALE AZ
85305-3421
US

V. Phone/Fax

Practice location:
  • Phone: 818-770-1879
  • Fax:
Mailing address:
  • Phone: 818-770-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: PHOEBE NALUBEGA
Title or Position: CEO
Credential:
Phone: 818-770-1879