Healthcare Provider Details

I. General information

NPI: 1730109935
Provider Name (Legal Business Name): GRACCTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4791 SUMMIT RIDGE DRIVE
RENO NV
89523
US

IV. Provider business mailing address

4791 SUMMIT RIDGE DRIVE
RENO NV
89523
US

V. Phone/Fax

Practice location:
  • Phone: 775-624-2200
  • Fax: 775-624-2211
Mailing address:
  • Phone: 775-624-2200
  • Fax: 775-624-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT J STEFANKO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 775-337-2012