Organization
GRACE SHORES RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH J ROBERTS MD (MEDICAL DIRECTOR)
(951) 894-6900
Entity
Organization
Contact information
Practice address
3170 MANISTEE DR, COSTA MESA, CA 92626-3124
(949) 220-3770
Mailing address
3170 MANISTEE DR, COSTA MESA, CA 92626-3124
(949) 220-3770
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D2080278
CA
Other
Enumeration date
07/18/2014
Last updated
07/18/2014
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