Provider Demographics
NPI:1962229203
Name:GRACIOUS ANGELS PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:GRACIOUS ANGELS PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-444-8636
Mailing Address - Street 1:813 IRVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-3105
Mailing Address - Country:US
Mailing Address - Phone:973-444-8636
Mailing Address - Fax:
Practice Address - Street 1:813 IRVINGTON AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-3105
Practice Address - Country:US
Practice Address - Phone:973-444-8636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty