Provider Demographics
NPI:1104136779
Name:GRANNYS HOMES FOR BOYS AND GIRLS RESIDENTIAL TREATMENT CENTER
Entity type:Organization
Organization Name:GRANNYS HOMES FOR BOYS AND GIRLS RESIDENTIAL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-499-3322
Mailing Address - Street 1:4631 ORKNEY DR.
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2807
Mailing Address - Country:US
Mailing Address - Phone:281-499-3322
Mailing Address - Fax:281-261-2579
Practice Address - Street 1:4631 ORKNEY DR.
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2807
Practice Address - Country:US
Practice Address - Phone:281-499-3322
Practice Address - Fax:281-261-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness