Graceful Phoenix Recovery Housing LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

GRACEFUL PHOENIX RECOVERY HOUSING LLC

Practice address

802 Walnut Grove Rd
Essex, MD 21221-6087

Phone

(443) 449-1862

NPI assigned

Aug 10, 2024

Organization subpart

No

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

Authorized official

Name

Teyana Johnson, CAC-ADNPI 1992410971

Title

Owner

Phone

(443) 449-1862

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Teyana A Johnson

  • Addiction (Substance Use Disorder) Counselor
  • Essex, MD
  • NPI 1992410971
  NPD Authorized official

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

{
    "created_epoch": "1723248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723248000000",
    "number": "1518798651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 WALNUT GROVE RD",
            "city": "ESSEX",
            "state": "MD",
            "postal_code": "212216087",
            "telephone_number": "443-449-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 WALNUT GROVE RD",
            "city": "ESSEX",
            "state": "MD",
            "postal_code": "212216087",
            "telephone_number": "443-449-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEFUL PHOENIX RECOVERY HOUSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-10",
        "last_updated": "2024-08-10",
        "certification_date": "2024-08-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TEYANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-449-1862",
        "authorized_official_credential": "CAC-AD"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Yanai Daxia Green, DC, MS
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• Roxann L Gunther
• Eyerusalem Hagos
• Kamal Alexander Hamod, M.D.

• Substance Abuse Rehabilitation Facility in Essex, MD
• Providers in Essex, MD by specialty
• Substance Abuse Rehabilitation Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.