MEDICARE: GRAND MANNER, INC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932328572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND MANNER, INC

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-0040
Country	:	US
Telephone Number	:	440-428-9082
Fax Number	:	440-428-5399

Provider Business Practice Location Address
First Line	:	1954 HUBBARD RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-2154
Country	:	US
Telephone Number	:	440-428-9082
Fax Number	:	440-428-5399

Authorized Official
Title or Position	:	CEO-OWNER
Name	:	MR. GARY A TOTH
Credential	:
Telephone Number	:	440-428-9082

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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Directions to “GRAND MANNER, INC ” Practice Location

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