Healthcare Provider Details

I. General information

NPI: 1477025534
Provider Name (Legal Business Name): GRACE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GALESI DR STE 26
WAYNE NJ
07470-4841
US

IV. Provider business mailing address

52 ELBERON AVE
PATERSON NJ
07502-2025
US

V. Phone/Fax

Practice location:
  • Phone: 973-769-3699
  • Fax:
Mailing address:
  • Phone: 973-769-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LASHONE ARNETT
Title or Position: OWNER
Credential: LCSW
Phone: 973-769-3699