Provider Demographics
NPI:1417689456
Name:GRYPHEN SPECIALTY PRODUCTS AND SERVICES LLC
Entity Type:Organization
Organization Name:GRYPHEN SPECIALTY PRODUCTS AND SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-370-6948
Mailing Address - Street 1:3120 N ARIZONA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7160
Mailing Address - Country:US
Mailing Address - Phone:480-320-3601
Mailing Address - Fax:480-820-7803
Practice Address - Street 1:3120 N ARIZONA AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7160
Practice Address - Country:US
Practice Address - Phone:480-320-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services