MEDICARE: LAVINNY GRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1487295630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVINNY GRAY

Provider Business Mailing Address
First Line	:	1440 LAURA LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-3739
Country	:	US
Telephone Number	:	214-609-3777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 LAURA LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-3739
Country	:	US
Telephone Number	:	214-609-3777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	10/22/2019

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Directions to “ LAVINNY GRAY ” Practice Location

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