Provider Demographics
NPI:1417346503
Name:GRAY-DAVIS SERVICES
Entity Type:Organization
Organization Name:GRAY-DAVIS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:OTELIA
Authorized Official - Middle Name:TRIPLETT
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-983-3884
Mailing Address - Street 1:585 SEVEN ELEVEN RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-2945
Mailing Address - Country:US
Mailing Address - Phone:434-983-3884
Mailing Address - Fax:434-983-3883
Practice Address - Street 1:585 SEVEN ELEVEN RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2945
Practice Address - Country:US
Practice Address - Phone:434-983-3884
Practice Address - Fax:434-983-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle