Provider Demographics
NPI:1174066955
Name:GRACE RECOVERY AND WELLNESS CENTER
Entity type:Organization
Organization Name:GRACE RECOVERY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAHA
Authorized Official - Suffix:
Authorized Official - Credentials:CPRP
Authorized Official - Phone:804-399-9042
Mailing Address - Street 1:PO BOX 3382
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-3382
Mailing Address - Country:US
Mailing Address - Phone:804-399-9042
Mailing Address - Fax:877-244-4588
Practice Address - Street 1:8217 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6413
Practice Address - Country:US
Practice Address - Phone:804-399-9042
Practice Address - Fax:877-244-4588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAILY GRACE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982901245OtherNPI