Provider Demographics
NPI:1497109573
Name:JAMES DOUGLASS GRAY
Entity Type:Organization
Organization Name:JAMES DOUGLASS GRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOUGLASS
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-242-2164
Mailing Address - Street 1:1530 FRANKLIN AVE
Mailing Address - Street 2:NONE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5910
Mailing Address - Country:US
Mailing Address - Phone:513-242-2164
Mailing Address - Fax:
Practice Address - Street 1:1530 FRANKLIN AVE
Practice Address - Street 2:NONE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5910
Practice Address - Country:US
Practice Address - Phone:513-242-2164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.196388311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home