GRACE LAND RECOVERY LLC NPI 1245821966

NPI Information

NPI: 1245821966
Provider Name: GRACE LAND RECOVERY LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 44D2229450

Address:
134 TIMBER CREEK DR
CORDOVA, TN
ZIP 38018
Phone: (901) 519-2655
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GRACE LAND RECOVERY LLC is a rehabilitation and substance use disorder clinic center in Cordova, TN. GRACE LAND RECOVERY LLC NPI is 1245821966. The provider is registered as an organization entity type.

The provider's business location address is:

134 TIMBER CREEK DR
CORDOVA, TN
ZIP 38018-291
Phone: (901) 519-2655
Fax: (404) 698-1497

The provider's authorized official is Brett Aric Nelson .
The authorized official title is Medical Director and has the following contact phone number (404) 620-9745.

The CLIA number assigned to this NPI record is 44D2229450 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/27/2021 and was last updated on 12/22/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center				No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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