Provider Demographics
NPI:1033782834
Name:GRAY'S ANGELS LLC
Entity Type:Organization
Organization Name:GRAY'S ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-572-4300
Mailing Address - Street 1:1822 HICKORY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-6402
Mailing Address - Country:US
Mailing Address - Phone:828-572-4300
Mailing Address - Fax:828-572-4302
Practice Address - Street 1:1822 HICKORY BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-6402
Practice Address - Country:US
Practice Address - Phone:828-572-4300
Practice Address - Fax:828-572-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7094OtherVA