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General NPI Number Information
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NPI Number | 1295107381
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Entity Type | Organization
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Legal Business Name | HOPE & GRACE RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 3411 NW 9TH AVE # 703704
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City | OAKLAND PARK
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State | FL
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Zip | 33309-5946
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Country | US
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Telephone | 617-448-8721
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 POWERLINE RD SUITE 200
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City | OAKLAND PARK
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-616-8988
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Fax | 954-616-5951
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. KENNETH FITZEMEYER
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Credential |
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Telephone | 754-216-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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