Provider Demographics
NPI:1154074284
Name:GRAYFISH LLC
Entity Type:Organization
Organization Name:GRAYFISH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-431-8277
Mailing Address - Street 1:6703 SW SHADYVALE LN
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66619-1312
Mailing Address - Country:US
Mailing Address - Phone:785-431-8277
Mailing Address - Fax:785-266-3203
Practice Address - Street 1:6703 SW SHADYVALE LN
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66619-1312
Practice Address - Country:US
Practice Address - Phone:785-431-8277
Practice Address - Fax:785-266-3203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLSIDE MEDICAL CONNECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-29
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies