Provider Demographics
NPI:1164028445
Name:GRAPE ESCAPE
Entity Type:Organization
Organization Name:GRAPE ESCAPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-491-3015
Mailing Address - Street 1:355 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1117
Mailing Address - Country:US
Mailing Address - Phone:440-361-4214
Mailing Address - Fax:
Practice Address - Street 1:355 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1117
Practice Address - Country:US
Practice Address - Phone:440-361-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services