Healthcare Provider Details

I. General information

NPI: 1174066955
Provider Name (Legal Business Name): GRACE RECOVERY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8217 HULL STREET RD
NORTH CHESTERFIELD VA
23235-6413
US

IV. Provider business mailing address

PO BOX 3382
GLEN ALLEN VA
23058-3382
US

V. Phone/Fax

Practice location:
  • Phone: 804-399-9042
  • Fax: 877-244-4588
Mailing address:
  • Phone: 804-399-9042
  • Fax: 877-244-4588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON L TAHA
Title or Position: EXECUTIVE DIRECTOR
Credential: CPRP
Phone: 804-399-9042