Gratitude Lodge LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

GRATITUDE LODGE LLC

Practice address

3010 E 1St St
Long Beach, CA 90803-2535

Phone

(800) 994-2184

Fax

(888) 411-0151

NPI assigned

Feb 16, 2024

Organization subpart

Yes

Parent organization

GRATITUDE LODGE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Williams

Title

Ceo

Phone

(800) 994-2184

Specialties & licenses 1

Addresses

Tax ID family

Gratitude Lodge LLC5 organizations share this tax ID, including this one

Part of

Gratitude Lodge LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Gratitude Lodge

  • Substance Abuse Rehabilitation Facility
  • Newport Beach, CA
  • NPI 1598340796
  NPD tax ID
• Gratitude Lodge LLC

  • Substance Abuse Rehabilitation Facility
  • Long Beach, CA
  • NPI 1033695754
  NPD tax ID
• Gratitude Lodge LLC

  • Substance Abuse Rehabilitation Facility
  • Newport Beach, CA
  • NPI 1578193678
  NPD tax ID
• Gratitude Lodge LLC

  • Substance Abuse Rehabilitation Facility
  • Newport Beach, CA
  • NPI 1992494306
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708041600000",
    "number": "1083479216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 E 1ST ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908032535",
            "telephone_number": "800-994-2184",
            "fax_number": "888-411-0151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 E 1ST ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908032535",
            "telephone_number": "800-994-2184",
            "fax_number": "888-411-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRATITUDE LODGE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRATITUDE LODGE LLC",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-994-2184",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zariah Grant
• Connie Fay Grantham, D.C.
• Dezon Granville
• Mario Max Granville
• Gratitude Lodge LLC
• Bryon Graulich, ATC, PTA
• Daphne Graves
• Lesley M Graves, PH.D.
• Malaika Elise Graves, M.D.
• Richard Henry Graves III, D.P.M.

• Substance Abuse Rehabilitation Facility in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.