Grand Terrace Detox and Recovery

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

330168AP Issued in CA

Legal business name

GRAND TERRACE DETOX AND RECOVERY

Practice address

18989 Grand Ave
Lake Elsinore, CA 92530-6259

Phone

(954) 210-8617

Fax

(954) 982-2827

NPI assigned

Aug 15, 2017

Organization subpart

No

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

Authorized official

Name

Eric McCoy

Title

Program Director

Phone

(954) 446-3538

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154847838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18989 GRAND AVE",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925306259",
            "telephone_number": "954-210-8617",
            "fax_number": "954-982-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18989 GRAND AVE",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925306259",
            "telephone_number": "954-210-8617",
            "fax_number": "954-982-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TERRACE DETOX AND RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "954-446-3538"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "330168AP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE AND CERTIFICATION",
            "identifier": "330168AP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alajah Goodman
• Gary Alan Gorrell, D.D.S.
• Gowda Professional Dental Inc
• James Morriss Grady II
• Giselle Grajeda
• Philip Grande, LMFT
• Savannah Granic
• Felene Grant, MA
• Nakisha Lavon Grant
• Amber Deneen Gray, PHD, DBH, CDVC, CVIS

• Substance Abuse Rehabilitation Facility in Lake Elsinore, CA
• Providers in Lake Elsinore, 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 Jul 21, 2022; 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.