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General NPI Number Information
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NPI Number | 1831712801
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Entity Type | Organization
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Legal Business Name | GRACE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 05/25/2020
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Last Update Date | 05/04/2025
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Provider Practice Location Address
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Address Line | 5700 LAKE WORTH RD STE 211
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City | GREENACRES
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State | FL
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Zip | 33463-3275
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Country | US
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Telephone | 561-331-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 11191 GRANDVIEW MNR
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City | WELLINGTON
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State | FL
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Zip | 33414-8840
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Country | US
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Telephone | 561-317-2389
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CARLOS POVEDA
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Credential | MHA
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Telephone | 561-317-2389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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