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General NPI Number Information
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NPI Number | 1275822967
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Entity Type | Organization
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Legal Business Name | GRAYBEARD CONSTRUCTION LLC
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Dates
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Enumeration Date | 04/03/2011
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Last Update Date | 04/03/2011
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Provider Practice Location Address
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Address Line | 1158 CORNWALLIS WAY
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-1887
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Country | US
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Telephone | 610-945-5507
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Fax |
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Provider Business Mailing Address
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Address Line | 1158 CORNWALLIS WAY
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-1887
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Country | US
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Telephone | 610-945-5507
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTHONY GULEN
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Credential |
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Telephone | 610-945-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | PA066873
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License Number State | PA
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