Provider Demographics
NPI:1285344374
Name:GRAY, ENID JANENE
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:JANENE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22180 HADDEN RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2148
Mailing Address - Country:US
Mailing Address - Phone:216-407-0465
Mailing Address - Fax:
Practice Address - Street 1:22180 HADDEN RD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2148
Practice Address - Country:US
Practice Address - Phone:216-407-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care