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General NPI Number Information
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NPI Number | 1417814823
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Entity Type | Organization
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Legal Business Name | GRANT GARDENS
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2582 GRANT GARDENS RD
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City | ONA
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State | WV
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Zip | 25545
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Country | US
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Telephone | 304-743-4439
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Fax |
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Provider Business Mailing Address
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Address Line | 315 DEADERICK ST 1700 PMB 28
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City | NASHVILLE
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State | TN
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Zip | 37238-3000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL MCCULLA
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Credential |
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Telephone | 615-973-5503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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