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General NPI Number Information
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NPI Number | 1417346503
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Entity Type | Organization
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Legal Business Name | GRAY-DAVIS SERVICES
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 585 SEVEN ELEVEN RD
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City | CUMBERLAND
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State | VA
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Zip | 23040-2945
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Country | US
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Telephone | 434-983-3884
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Fax | 434-983-3883
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Provider Business Mailing Address
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Address Line | 585 SEVEN ELEVEN RD
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City | CUMBERLAND
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State | VA
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Zip | 23040-2945
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Country | US
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Telephone | 434-983-3884
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Fax | 434-983-3883
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Authorized Official
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Title or Position | OWNER
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Name | MS. OTELIA TRIPLETT GRAY
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Credential |
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Telephone | 434-983-3884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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