Grace Recovery and Wellness LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

GRACE RECOVERY AND WELLNESS LLC

Practice address

1400 Broadway St
Anderson, IN 46012-2535

Phone

(888) 228-5485

Fax

(765) 393-2563

NPI assigned

Apr 11, 2019

Organization subpart

No

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

Authorized official

Name

Robert Slack

Title

Director of It

Phone

(888) 228-5485

Specialties & licenses 1

Addresses

Tax ID family

Grace Recovery and Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Grace Recovery and Wellness LLC

  • Substance Abuse Rehabilitation Facility
  • Anderson, IN
  • NPI 1932069697
  NPD tax ID

Locations

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1881157329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BROADWAY ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460122535",
            "telephone_number": "888-228-5485",
            "fax_number": "765-393-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BROADWAY ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460122535",
            "telephone_number": "888-228-5485",
            "fax_number": "765-393-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE RECOVERY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR OF IT",
        "authorized_official_telephone_number": "888-228-5485"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryleigh Eryn Goodwin, BCABA
• Nancy M Goodwine-Wozniak, MD
• Phillip Goshert, MD
• Sayla L Gossard, LCSW
• Grace in Vision
• Grace Recovery and Wellness LLC
• Abby Graham
• Sydnee Alexis Granger, RBT
• Mackenzie Gray
• Randall Gray, PMHNP-BC

• Substance Abuse Rehabilitation Facility in Anderson, IN
• Providers in Anderson, IN by specialty
• Substance Abuse Rehabilitation Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.