Organization
GRACE SHORES RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA EDGE (FOUNDER/DIRECTOR)
(949) 220-3770
Entity
Organization
Contact information
Practice address
2554 ELDEN AVE, B103, COSTA MESA, CA 92627-5127
(949) 220-3770
Mailing address
2554 ELDEN AVE, B103, COSTA MESA, CA 92627-5127
(949) 220-3770
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D2080278
CA
Other
Enumeration date
05/09/2016
Last updated
05/09/2016
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