Healthcare Provider Details

I. General information

NPI: 1245305002
Provider Name (Legal Business Name): ANNE GRADY DAY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 TRADE RD
HOLLAND OH
43528-8204
US

IV. Provider business mailing address

1525 EBER RD
HOLLAND OH
43528-9616
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-6500
  • Fax: 419-866-7457
Mailing address:
  • Phone: 419-866-6500
  • Fax: 419-866-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN KING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-866-6500