Provider Demographics
NPI:1013208651
Name:GRANT SERVICES FOR THE DISABLED , INC.
Entity Type:Organization
Organization Name:GRANT SERVICES FOR THE DISABLED , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-879-5507
Mailing Address - Street 1:1603 HIDDEN HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3815
Mailing Address - Country:US
Mailing Address - Phone:770-879-5507
Mailing Address - Fax:678-691-4082
Practice Address - Street 1:1603 HIDDEN HILLS PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3815
Practice Address - Country:US
Practice Address - Phone:770-879-5507
Practice Address - Fax:678-691-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-01-396-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA#032168215BMedicaid