Provider Demographics
NPI:1588140651
Name:GRANTHAM FAMILY HOME INC
Entity type:Organization
Organization Name:GRANTHAM FAMILY HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIAN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-344-8870
Mailing Address - Street 1:1223 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6713
Mailing Address - Country:US
Mailing Address - Phone:919-344-8870
Mailing Address - Fax:
Practice Address - Street 1:1223 PORTER ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6713
Practice Address - Country:US
Practice Address - Phone:919-344-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care