Healthcare Provider Details

I. General information

NPI: 1427298272
Provider Name (Legal Business Name): GRAYMOOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GREEN ST
HOULTON ME
04730-1637
US

IV. Provider business mailing address

24 GREEN ST
HOULTON ME
04730-1637
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-0937
  • Fax: 207-532-2646
Mailing address:
  • Phone: 207-532-0937
  • Fax: 207-532-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number409940000
License Number StateME

VIII. Authorized Official

Name: MR. TERRILL D SPINNEY
Title or Position: ADMIN/OWNER
Credential: R.N.
Phone: 207-532-0937