Healthcare Provider Details

I. General information

NPI: 1417346503
Provider Name (Legal Business Name): GRAY-DAVIS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SEVEN ELEVEN RD
CUMBERLAND VA
23040-2945
US

IV. Provider business mailing address

585 SEVEN ELEVEN RD
CUMBERLAND VA
23040-2945
US

V. Phone/Fax

Practice location:
  • Phone: 434-983-3884
  • Fax: 434-983-3883
Mailing address:
  • Phone: 434-983-3884
  • Fax: 434-983-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. OTELIA TRIPLETT GRAY
Title or Position: OWNER
Credential:
Phone: 434-983-3884