Provider Demographics
NPI:1689413643
Name:GRACE ABOUNDS RECOVERY, LLC.
Entity type:Organization
Organization Name:GRACE ABOUNDS RECOVERY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETUKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-696-8162
Mailing Address - Street 1:114 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2132
Mailing Address - Country:US
Mailing Address - Phone:732-696-8162
Mailing Address - Fax:
Practice Address - Street 1:114 ROUTE 34
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2132
Practice Address - Country:US
Practice Address - Phone:732-696-8162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE ABOUNDS COUNSELING & PSYCHOLOGICAL CONSULTIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)