Provider Demographics
NPI:1528647617
Name:GRAYS ADULT ACTIVITY HOME
Entity type:Organization
Organization Name:GRAYS ADULT ACTIVITY HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVINNY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-244-7865
Mailing Address - Street 1:1440 LAURA LANE DALLAS
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241
Mailing Address - Country:US
Mailing Address - Phone:214-609-3777
Mailing Address - Fax:
Practice Address - Street 1:1440 LAURA LANE DALLAS
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241
Practice Address - Country:US
Practice Address - Phone:121-460-9377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care