| NPI | 1417494857 |
|---|---|
| Other Name | GRACE STREET SERVICES PORTLAND |
| Entity Type | Organization |
| Authorized Contact | BRANDY BOYLE Billing Contact 207-245-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |