Provider Demographics
NPI:1043083439
Name:THE GRACEFUL HOPE FOUNDATION
Entity type:Organization
Organization Name:THE GRACEFUL HOPE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR/PRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKITA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:863-662-4076
Mailing Address - Street 1:111 W CENTRAL AVE UNIT 956
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33882-7040
Mailing Address - Country:US
Mailing Address - Phone:863-662-4076
Mailing Address - Fax:863-588-3152
Practice Address - Street 1:99 6TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-7902
Practice Address - Country:US
Practice Address - Phone:863-662-4076
Practice Address - Fax:863-588-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)