MEDICARE: GRACE'S WAY RECOVERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1831581743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE'S WAY RECOVERY

Provider Business Mailing Address
First Line	:	2200 N FLORIDA MANGO RD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6464
Country	:	US
Telephone Number	:	561-275-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N FLORIDA MANGO RD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6464
Country	:	US
Telephone Number	:	561-275-1600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BERNIE SCHULTZ
Credential	:
Telephone Number	:	561-275-1600

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/03/2015

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Directions to “GRACE'S WAY RECOVERY ” Practice Location

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