Organization · NPI-2

Grace Behavioral Health Services

Nurse Practitioner, Psych/Mental Health · Brick, NJ

NPI number1437766375
StatusActive
Last updated in NPPESAug 29, 2023

Details

NPI
1437766375
Entity type
Organization (NPI-2)
Legal business name
Grace Behavioral Health Services
Organization subpart
No
Enumeration date
Sep 24, 2020
Certification date
Aug 29, 2023
Last updated
Aug 29, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0808X Nurse Practitioner, Psych/Mental Health––Yes
261QM0850X Clinic/Center, Adult Mental Health––
261QM0855X Clinic/Center, Adolescent and Children Mental Health––

Practice location

1140 Burnt Tavern Rd Ste 1a
Brick, NJ 08724-1496

Phone 908-417-0632

Mailing address

Po Box 46
Lakehurst, NJ 08733-0046

Phone 908-417-0632

Authorized official

Omezie Molokwu
President
9084170632

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