Organization
GRACEFUL HEART LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IBRAHIM FOFANAH (ADMINISTRATOR)
(602) 880-0863
Entity
Organization
Contact information
Practice address
2401 W GLENDALE AVE STE 102B, PHOENIX, AZ 85021-7621
(602) 880-0323
Mailing address
2401 W GLENDALE AVE STE 102B, PHOENIX, AZ 85021-7621
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/14/2023
Last updated
03/14/2023
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