Provider Demographics
NPI:1114502135
Name:GRAND THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:GRAND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:TROYD
Authorized Official - Last Name:LEGRAND
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L; CAPS
Authorized Official - Phone:678-900-4118
Mailing Address - Street 1:36 S CHARLES ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3121
Mailing Address - Country:US
Mailing Address - Phone:410-878-1014
Mailing Address - Fax:404-393-5069
Practice Address - Street 1:36 S CHARLES ST STE 203
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3121
Practice Address - Country:US
Practice Address - Phone:410-878-1014
Practice Address - Fax:404-393-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)