Provider Demographics
NPI:1235901406
Name:STANLEY, GARRETT RAY
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:RAY
Last Name:STANLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SENIOR CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9581
Mailing Address - Country:US
Mailing Address - Phone:304-619-6846
Mailing Address - Fax:
Practice Address - Street 1:23 SENIOR CENTER DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9581
Practice Address - Country:US
Practice Address - Phone:304-619-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker