Healthcare Provider Details

I. General information

NPI: 1962122291
Provider Name (Legal Business Name): GRATEFUL WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 LOCH MOUNT DR
LOVELAND CO
80537-4539
US

IV. Provider business mailing address

1304 LOCH MOUNT DR
LOVELAND CO
80537-4539
US

V. Phone/Fax

Practice location:
  • Phone: 970-342-5440
  • Fax:
Mailing address:
  • Phone: 970-342-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMMY BRANNEN
Title or Position: OWNER
Credential: LCSW
Phone: 970-342-5440