Provider Demographics
NPI:1275822967
Name:GRAYBEARD CONSTRUCTION LLC
Entity Type:Organization
Organization Name:GRAYBEARD CONSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GULEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-945-5507
Mailing Address - Street 1:1158 CORNWALLIS WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1887
Mailing Address - Country:US
Mailing Address - Phone:610-945-5507
Mailing Address - Fax:
Practice Address - Street 1:1158 CORNWALLIS WAY
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1887
Practice Address - Country:US
Practice Address - Phone:610-945-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA066873171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty