Healthcare Provider Details

I. General information

NPI: 1760829485
Provider Name (Legal Business Name): GRANT ME THE COURAGE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 E BIRCH ST STE 101
BREA CA
92821-6266
US

IV. Provider business mailing address

3350 E BIRCH ST STE 101
BREA CA
92821-6266
US

V. Phone/Fax

Practice location:
  • Phone: 877-290-2058
  • Fax: 866-659-9110
Mailing address:
  • Phone: 877-290-2058
  • Fax: 866-659-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BAUTISTA
Title or Position: CFO
Credential:
Phone: 714-262-9521