| Grace Harbour, Inc | |
|
200 Westpark Dr Ste 325 Peachtree City GA 30269-3574 | |
| (770) 486-1140 | |
| (678) 669-2693 |
| Full Name | Grace Harbour, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 200 Westpark Dr Ste 325, Peachtree City, Georgia |
| Authorized Official Name and Position | Kevin Freeman (SENIOR VICE PRESIDENT) |
| Authorized Official Contact | 4049349244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Harbour, Inc 200 Westpark Dr Ste 325 Peachtree City GA 30269-3574 Ph: (770) 486-1140 | Grace Harbour, Inc 200 Westpark Dr Ste 325 Peachtree City GA 30269-3574 Ph: (770) 486-1140 |
| NPI Number | 1407072770 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Medicare PECOS PAC ID | 5890964969 |
|---|---|
| Medicare Enrollment ID | O20160203001599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407072770 | NPI | - | NPPES |
| 684485156A | Medicaid | GA | |
| 7680934 | Other | AETNA | |
| 600073520 | Other | MAGELLAN |
| Provider Name | Winston R Pineda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831142546 PECOS PAC ID: 8426072703 Enrollment ID: I20060125000799 |
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