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General NPI Number Information
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NPI Number | 1407617319
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Entity Type | Organization
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Legal Business Name | GRACEFUL OLIVES HEALTH
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 315-547-0502
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Fax | 727-382-0311
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Provider Business Mailing Address
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Address Line | 8403 PINES BLVD # 1440
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6609
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Country | US
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Telephone | 954-710-9062
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Fax | 954-405-8681
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Authorized Official
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Title or Position | OWNER
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Name | UGOCHI NWANYIETODI NWAOBI
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Credential | PMHNP
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Telephone | 352-286-9347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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