Healthcare Provider Details

I. General information

NPI: 1740037027
Provider Name (Legal Business Name): GRAY HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 41ST ST
COUNCIL BLUFFS IA
51501-1796
US

IV. Provider business mailing address

505 N 41ST ST
COUNCIL BLUFFS IA
51501-1796
US

V. Phone/Fax

Practice location:
  • Phone: 402-315-8906
  • Fax:
Mailing address:
  • Phone: 402-315-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ELMER GRAY
Title or Position: PRESIDENT
Credential:
Phone: 402-315-8906