Healthcare Provider Details

I. General information

NPI: 1033042254
Provider Name (Legal Business Name): RESTORATION BY GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 SW 10TH ST
NORTH LAUDERDALE FL
33068-2630
US

IV. Provider business mailing address

6511 SW 10TH ST
NORTH LAUDERDALE FL
33068-2630
US

V. Phone/Fax

Practice location:
  • Phone: 754-715-9476
  • Fax:
Mailing address:
  • Phone: 754-715-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY CELCIS
Title or Position: COMPLIANCE DIRECTOR
Credential: MSW
Phone: 702-237-7519