Provider Demographics
NPI:1316765365
Name:GRAND TRAVERSE INDUSTRIES, INC.
Entity type:Organization
Organization Name:GRAND TRAVERSE INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-922-4886
Mailing Address - Street 1:2170 TRAVERSEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-9278
Mailing Address - Country:US
Mailing Address - Phone:231-922-4886
Mailing Address - Fax:231-922-4894
Practice Address - Street 1:2170 TRAVERSEFIELD DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9278
Practice Address - Country:US
Practice Address - Phone:231-922-4886
Practice Address - Fax:231-922-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health