Provider Demographics
NPI:1063682094
Name:DALE GRAY, INC.
Entity Type:Organization
Organization Name:DALE GRAY, INC.
Other - Org Name:AMERICAN HOME CAREGIVERS AND NURSES REGISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:QUISUMBING
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:888-897-3166
Mailing Address - Street 1:605 S VERDUGO RD
Mailing Address - Street 2:#3
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2761
Mailing Address - Country:US
Mailing Address - Phone:818-331-1176
Mailing Address - Fax:818-507-6503
Practice Address - Street 1:14536 ROSCOE BLVD
Practice Address - Street 2:STE. 97
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4103
Practice Address - Country:US
Practice Address - Phone:888-897-3166
Practice Address - Fax:818-894-4422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALE GRAY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002305175-0001-7251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health