Healthcare Provider Details

I. General information

NPI: 1538995311
Provider Name (Legal Business Name): HEALING GRACE WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 SE 57TH DR
OKEECHOBEE FL
34974-1752
US

IV. Provider business mailing address

8775 SE 57TH DR
OKEECHOBEE FL
34974-1752
US

V. Phone/Fax

Practice location:
  • Phone: 863-447-7378
  • Fax:
Mailing address:
  • Phone: 863-447-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA GRACE BOONE
Title or Position: OWNER
Credential: APRN
Phone: 863-447-7378