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General NPI Number Information
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NPI Number | 1275809402
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Entity Type | Organization
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Legal Business Name | GRASS ROOTS RECOVERY
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 719 PLACE CHATEAU
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2212
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Country | US
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Telephone | 561-313-4562
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Fax | 561-444-2715
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Provider Business Mailing Address
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Address Line | 516 BISCAYNE DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-7602
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Country | US
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Telephone | 561-313-4562
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Fax | 561-444-2715
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Authorized Official
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Title or Position | OWNER/CEO
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Name | CHI SEPPALA
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Credential |
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Telephone | 561-313-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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