MEDICARE: GR&M NONPROFIT FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1518298827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GR&M NONPROFIT FOUNDATION

Provider Business Mailing Address
First Line	:	3431 QUAIL HIGH BLVD
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7016
Country	:	US
Telephone Number	:	440-539-3184
Fax Number	:

Provider Business Practice Location Address
First Line	:	3431 QUAIL HIGH BLVD
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7016
Country	:	US
Telephone Number	:	440-539-3184
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MS. MIA FELICE STUBBS
Credential	:
Telephone Number	:	440-539-3184

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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